Lyme Disease and Neuropathy
BY JOHN J. HALPERIN, M.D.
Lyme disease is an infectious illness, caused by a corkscrew-shaped bacterium (belonging to the spirochete group of bacteria) known as Borrelia Burgdorferi. This infection is transmitted almost exclusively by bites of very small, hard-shelled ticks. Although these ticks are found in many locations, in the United States, Lyme disease is found primarily on the eastern seaboard (from Southern Maine to Maryland), in the upper Midwest (in Wisconsin and Minnesota), and, to a lesser extent, in Northern California. Notably, a virtually identical illness has been known in Europe for decades.
Ticks must be attached and feeding for at least a day or two before a person is at risk of becoming infected. The most typical initial sign of infection is an unusual rash, erythema migrans, appearing at the bite site several days to a few weeks after the bite. The rash is typically painless, red and round to oval, enlarging from day to day reflecting the outward migration of bacteria from the site of the bite (hence the name migrans). This may be accompanied by fever, headache and other typical signs of an infection, but not by respiratory or stomach symptoms.
In the first weeks to few months after infection, the bacteria may spread to other parts of the body; common sites include the heart (primarily causing problems with the heart’s electrical conduction system), the nervous system and the joints.
Nervous system involvement results from inflammation of the lining of the brain – “meningitis” – in this case a harmless but uncomfortable illness that will subside even without treatment, but more rapidly if treated with antibiotics. Five to ten percent of patients develop paralysis of one or both sides of the face, which, again, resolves over weeks to months in the vast majority of patients.
Another early neurological symptom is radiculitis. Radiculitis involves inflammation of a nerve or its root and causes symptoms very similar to sciatica and other pinched nerves. The affected nerves control muscles and sensations in specific parts of the body. Patients experience localized weakness, numbness or pain dictated by which nerve is involved.
Other types of neurologic involvement are less common. In people with untreated Lyme disease for longer periods of time, a more widespread involvement of nerves— i.e. a peripheral neuropathy—can occur. This can resemble diffuse neuropathies with numbness, tingling and weakness starting at the most distant parts of the body (fingers and toes), progressing gradually over time.
Although there is a lot of controversy about the treatment of Lyme disease,
2-4 week antibiotic regimens are highly effective, particularly in peripheral neuropathies. Intravenous antibiotics such as ceftriaxone, cefotaxime or high-dose penicillin are highly efficacious. Recent European studies indicate that oral antibiotics such as doxycycline are equally effective. Although Lyme disease can affect peripheral nerves in many different ways, in the vast majority of circumstances, they are reversible. Like virtually every other known bacterial infection, Lyme disease can be treated with antibiotics.
John J. Halperin, M.D. is Professor of Neurology at Mount Sinai School of
Medicine and Medical Director of Neuroscience for Atlantic Health System.
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An explanation of peripheral neuropathy
Dr. Stephanie Miller | Posted: Sunday, March 25, 2012
Why do my hands and feet tingle and burn?
Peripheral neuropathy is one of the primary causes of tingling, burning and/or numbness in hands and/or feet. Nerves in the peripheral nervous system send information from the brain and spinal cord to other parts of the body and back again. If nerves are damaged, peripheral neuropathy can result. It most commonly starts in the longest nerves that reach to your toes. Depending on which nerves are affected, symptoms may vary.
Does peripheral neuropathy affect only hands and feet?
The tingling or numbness usually begins in the hands or feet but it may spread up into the legs and arms. It can turn into burning or jabbing pain. Skin may become extremely sensitive to touch. If motor nerves are impacted, muscle weakness or paralysis is possible. If autonomic nerves are affected, bowel or bladder problems may develop. Peripheral neuropathy can affect only one nerve or it may affect many nerves.
Who is at risk for peripheral neuropathy?
At least 50 percent of people with diabetes develop some form of neuropathy. Others commonly at high risk are alcoholics, who often have vitamin deficiencies due to poor dietary choices; people with autoimmune diseases such as rheumatoid arthritis and lupus; those exposed to toxic substances, certain medications, viral or bacterial infections, and nerve trauma such as repetitive sports injuries or accidents where nerves are damaged.
When should I see a doctor?
Any time you notice tingling, weakness or pain in your hands or feet, you should make an appointment with a primary care doctor or a neurologist, a doctor that specializes in disorders of the nervous system. Because peripheral neuropathy isn't a single disease, it can be difficult to diagnose. Determining the location of the nerve damage and its cause is important for successful treatment.
How does a doctor treat peripheral neuropathy?
When your doctor determines the cause of your peripheral neuropathy and treats that underlying cause, the neuropathy often improves. Several different prescription medications can reduce the pain. Your doctor will evaluate the degree of your neuropathy and work with you to find the best medications for your particular symptoms and type of neuropathy.
What can I do to reduce symptoms?
Wear soft cotton socks and shoes with good padding and support. A hand or foot massage improves circulation, stimulates nerves and may decrease pain. If you have diabetes, good control of your sugar is necessary. If you smoke, quit. Smoking affects circulation, increasing your risk of foot problems and possible amputation. Healthy eating is essential because vitamin deficiencies can cause or increase neuropathy symptoms. Preventing further nerve damage is essential. The right kind of regular exercise can reduce pain. Talk to your doctor about a healthy eating and exercise plan.
(Dr. Stephanie Miller is a neurologist at Bismarck Medcenter One Q&R Clinic. A graduate of the University of North Dakota School of Medicine and Health Sciences at Grand Forks, she completed an internship in internal medicine and a residency in neurology at Mayo School of Graduate Medicine, Rochester, Minn.)
Erectile dysfunction (ED) – inability to attain or maintain an erection sufficient to permit satisfactory sexual intercourse and ends up without any satisfaction to himself or his partner
