Archive for the ‘research’ Category

Conversion Disorder, Guillain-Barre Syndrome or Lyme Disease?

https://danielcameronmd.com/conversion-disorder-guillain-barre-syndrome-or-lyme-disease/

CONVERSION DISORDER, GUILLAIN-BARRÉ SYNDROME OR LYME DISEASE?

The authors of “Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations,” present a challenging diagnostic case involving a 62-year-old woman with symptoms consistent for multiple neurologic disorders.

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Teodoro and colleagues describe the case of a woman, who was initially suspected of having a conversion disorder but later diagnosed with Guillain-Barré syndrome, possibly triggered by an infection with Borrelia burgdorferi, the causative agent of  Lyme disease. ¹

(Conversion disorder is a mental condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.)

The woman reported to the emergency room with weakness in her left hand and both of her legs, which resulted in 2 consecutive falls with head trauma. Test results were normal, and she was discharged. But the following day her symptoms worsened, and she returned to the hospital with significant motor impairment (an inability to walk independently) and urinary incontinence.

“On admission, her neurological examination revealed asymmetric tetraparesis, hyporeflexia, doubtful hemihypesthesia, and left extensor plantar reflex,” writes Teodoro and colleagues in the journal Case Reports in Neurology.

(Tetraparesis means weakness in all extremities. Hemihypesthesia is a reduction in sensitivity on one side of the body.)

Conversion Disorder

The woman was initially treated for a conversion disorder since her findings suggested this diagnosis including “the absence of a typical pattern the reference to a positive Hoover sign in one of the early evaluations, inconsistent and fluctuating motor deficits, coinciding timeline with stressful life events, and a predominantly anxious basal affective state,” writes Teodoro.

The patient reported having a recent stressful event and symptoms of anxiety.  In turn, she was prescribed the antidepressant Sertraline (100mg) and Pregabalin (150mg), a nerve pain drug, also known as Lyrica.

But by day 5, the woman’s symptoms had worsened. Her upper and lower limbs were areflexic. And, needle electromyography revealed “a subacute motor axonal neuropathy pattern and a right median nerve mononeuropathy.”

Guillain-Barré syndrome

Guillain-Barré syndrome, an autoimmune disorder, was considered based on EMG findings and a spinal tap which revealed albuminocytologic dissociation, a hallmark finding of Guillain-Barré syndrome.

A 5-day course of 32 g/day of intravenous immunoglobulin (0.4 g/kg/day) was initiated and led to a partial improvement in motor function.

Lyme disease

She was subsequently diagnosed with Lyme disease based on a positive IgM titer and a repeat spinal tap, which showed an elevated mononuclear white blood cell count of 20/μL and positive IgM.

“None of the most common infectious agents associated with Guillain-Barré syndrome were identified.  Surprisingly serologies for Borrelia were revealed to be positive, with further finding of IgM Borrelia antibodies in CSF,” writes Teodoro.

“The possibility of a Guillain-Barré syndrome due to Borrelia infection should be considered,” the authors point out, “although this syndrome usually develops as a post-infectious syndrome.”

The woman was given a 14-day course of Ceftriaxone (2 g/day) and showed significant improvement in motor function. However, she was discharged requiring additional physical therapy and rehabilitation.

This is not the first case of a medical condition being diagnosed as a conversion disorder.  “There are case reports of Guillain-Barré syndrome misdiagnosed as a conversion disorder² highlighting the importance of considering the clinical heterogeneity of the possible presentations,” writes Teodoro.

Furthermore, although it is rare, there have been reports of Lyme disease mimicking Guillain-Barré syndrome.³

“This case highlights the importance of the differential diagnosis of atypical presentations of neurological disease, including the possibility of functional neurological symptoms,” the authors conclude.

Related Articles:

Lyme disease manifests as autoimmune disorder, Sjogrens Syndrome

Can Lyme disease trigger an autoimmune disease

Lyme disease mimics autoimmune disorder in elderly woman

References:
  1. Teodoro T, Oliveira R, Afonso P. Atypical Lyme Neuroborreliosis, Guillain-Barré Syndrome or Conversion Disorder: Differential Diagnosis of Unusual Neurological Presentations. Case Rep Neurol. 2019 Apr 30;11(1):142-147.
  2. Edelsohn G. Guillain-Barré misdiagnosed as conversion disorder. Hosp Community Psychiatry. 1982 Sep;33(9):766–7.
  3. Tyagi N, Maheswaran T, Wimalaratna S. Neuroborreliosis: the Guillain-Barré mimicker. BMJ Case Rep. 2015 Jun 25;2015.pii:bcr2014209080.

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For more:  https://madisonarealymesupportgroup.com/2019/01/09/transverse-myelitis-guillain-barre-associated-with-bartonella/

https://madisonarealymesupportgroup.com/2018/12/07/acute-flaccid-paralysis-is-most-often-guillain-barre-syndrome/

https://madisonarealymesupportgroup.com/2019/01/18/acute-transverse-myelitis-a-clinical-manifestation-of-lyme-that-nobody-has-a-clue-about-prevalence/

https://madisonarealymesupportgroup.com/2018/12/07/nevada-man-diagnosed-with-guillain-barre-syndrome-after-getting-flu-shot/

VARIOUS VACCINES ARE DEFINITELY CAUSING GBS.

https://madisonarealymesupportgroup.com/2018/10/19/rise-in-acute-flaccid-myelitis-cases-and-the-link-to-vaccinations/

https://madisonarealymesupportgroup.com/2016/11/07/connection-of-acute-flaccid-myelitis-and-vaccinations/ The connection between vaccination and paralysis has been known since the 40’s and 50’s and was written about in The Lancet by Stephen Mawdsley in an article titled, “Polio Provocation: Solving a Mystery With the Help of History.”

Mawdsley states:

“The application of epidemiological surveillance and statistical methods enabled researchers to trace the steady rise in polio incidence along with the expansion of immunization programs for diphtheria, pertussis, and tetanus. A report that emerged from Guy’s and Evelina Hospitals, London, in 1950, found that 17 cases of polio paralysis developed in the limb injected with pertussis or tetanus inoculations. Results published by Australian doctor Bertram McCloskey also showed a strong association between injections and polio paralysis. Meanwhile, in the USA, public health researchers in New York and Pennsylvania reached similar conclusions.Clinical evidence, derived from across three continents, had established a theory that required attention.”

Category:

Lyme, research

Complex Multisystemic Illnesses Lead to Psychiatric Diagnosis

https://danielcameronmd.com/complex-multisystemic-illnesses-lead-to-psychiatric-diagnosis/

COMPLEX MULTISYSTEMIC ILLNESSES LEAD TO PSYCHIATRIC DIAGNOSIS

All too frequently patients with complex, multisystem illnesses are dismissed by clinicians, their symptoms often attributed to a psychiatric illness simply as “a diagnosis of default,” writes Bransfield in “Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty.”¹ This attitude can lead to tragic delays in identifying a correct diagnosis and appropriate treatment.

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In their article, Bransfield et al. describe two patients with complex, multisystemic illnesses, which included Lyme disease. Both patients suffered from debilitating symptoms over several years, which left them unable to walk and confined to a wheelchair. Doctors dismissed their complaints, which ranged from fatigue and weight loss to seizures and cognitive impairments. They were labeled as having “hysteria” and “wanting attention.”

From martial arts athlete to wheelchair-bound

The first case involved a healthy, athletic 18-year-old female who was skilled at Taekwondo. The girl developed a Bull’s-eye rash, followed by Bell’s palsy. Over a 4-year period, she became increasingly disabled and eventually required a wheelchair. She also suffered from seizures.

The girl’s symptoms included: cognitive impairments (attention, memory, processing speed, concentration/executive functioning), tactile hypersensitivity, sun sensitivity, orthostatic hypotension, weight loss, fatigue, non-restorative sleep, pelvic pain, difficulty urinating, headaches, peripheral neuropathy, muscle atrophy, cervical radiculopathy, hair loss, costochondritis, subluxation of multiple joints, and generalized pain.

Clinicians initially diagnosed her with fibromyalgia, “wanting attention,” chronic fatigue syndrome, hypoglycemia, and pseudoseizures, according to Bransfield.

However, she was eventually diagnosed with late-stage Lyme borreliosis with multisystem symptoms, along with porphyria, Ehlers-Danlos/ALPIM syndrome (anxiety-laxity-pain-immune-mood) with seizures caused by increased intracranial pressure from cranio-cervical instability, writes Bransfield.

Upon further evaluation, clinicians diagnosed the girl with complex partial seizures, rather than ‘pseudoseizures.’

“The patient was subsequently treated,” writes Bransfield, “and is now physically active, married, and leading a productive life.”

From ‘hysteria’ diagnosis to encephalitis

A 12-year-old girl from England suffers from leg pain and is diagnosed with reactive arthritis. She is admitted to the hospital complaining of “excruciating headaches, a complete loss of balance, and involuntary jerking movements,” explains Bransfield. The girl was discharged but her symptoms worsened.

One clinician’s assessment described the girl’s condition as “Hysteria, possible conversion disorder.” The patient “was left deteriorating and untreated, by which time she was having constant seizures and needed a wheelchair,” writes Bransfield.

Unfortunately, doctors ignored repeated requests by the mother to consider Lyme disease, as the family lived in an endemic region and other family members had been infected.

The girl was moved to another clinic where she was diagnosed with “encephalitis and possible encephalomyelitis (inflammation of the brain/brainstem/spinal cord), probably due to Lyme disease,” writes Bransfield.

She immediately began IV antibiotics and within 36 hours, the girl’s seizures had stopped and her headaches began to subside. Tests for Lyme disease came back positive.

After 2 months of IV treatment, the patient was able to walk again. But once antibiotics were stopped, the symptoms returned. The girl continued treatment in the United States but reported having persistent symptoms due to a delay in treatment.

Making the diagnosis can be difficult.

“Some healthcare providers have great difficulty understanding and making an accurate diagnosis when these symptoms are present and categorize them as being ‘vague’ or ‘subjective’ symptoms and, therefore, less valid,” writes Bransfield.

Individuals can be mislabeled as hypochondriacs.

“The number and the complexity of these symptoms can be overwhelming to the patient, and the patient may be labeled as being hypochondriacal, a psychosomatic illness, or having bodily distress disorder or somatic symptom disorder,” writes Bransfield.

“Historically, there has been a tendency to label physical symptoms that could not be explained as being of a psychiatric origin,” writes Bransfield.

“As a result, many patients with complex, confusing symptoms and poorly understood diseases who receive an inadequate assessment for their condition are often referred to psychiatrists until the time when the disease is better understood and defined.”

Related Articles:

Seizures and altered mental status after a tick bite

Dismissing chronic Lyme disease for somatic symptom disorder diagnosis

Yale doctor says children don’t have Lyme but medically unexplained symptoms

References:
  1. Bransfield RC, Friedman KJ. Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses and Medical Uncertainty. Healthcare 2019, 7, 114.

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**Comment**

Thank God for practitioners like Dr. Bransfield who continually show the devastation tick-borne illness can cause.

Please note the quick response and alleviation of symptoms when appropriate treatment is given.  The problem is that many are still misdiagnosed and untreated – yet suffering just like those mentioned in this article.

For more:  https://madisonarealymesupportgroup.com/2018/04/15/ld-the-brain-podcast-with-dr-bransfield/

https://madisonarealymesupportgroup.com/2019/11/22/differentiating-psychosomatic-somatopsychic-multisystem-illnesses-and-medical-uncertainty/

https://madisonarealymesupportgroup.com/2019/11/29/its-all-in-your-head-medicines-silent-epidemic/

https://madisonarealymesupportgroup.com/2019/05/27/have-you-been-told-its-all-in-your-head-the-new-biology-of-mental-illness/

https://madisonarealymesupportgroup.com/2017/06/20/suicide-lyme-and-associated-diseases/

https://madisonarealymesupportgroup.com/2015/10/18/psychiatric-lymemsids/

Category:

Lyme, Psychological Aspects, research, Treatment

5 Things to Know About Chronic Inflammatory Demyelinating Polyneuropathy (The 6th Thing is Lyme Can Cause It)

https://www.medscape.com/viewarticle/918480?

5 Things to Know About Chronic Inflammatory Demyelinating Polyneuropathy

By Ariel Harsinay

September 20, 2019

Chronic inflammatory demyelinating polyneuropathy (CIDP) may be a rare disease, but it is one of the most common forms of neuropathy and the most common form of chronic autoimmune neuropathy. Roughly 30,000 Americans are currently diagnosed with CIDP. Unlike many other neuropathies, CIDP is treatable, but its similarities with other nerve disorders often make it extremely difficult to diagnose. Here are five things to know about CIDP.

1. CIDP is an autoimmune disorder that attacks the peripheral nervous system.

CIDP is an autoimmune, neurologic condition in which the myelin sheath surrounding the axons of neurons is attacked by the immune system, causing demyelination. Myelin normally serves as axonal insulation, allowing neurons to rapidly transmit action potentials and communicate with neighboring neurons. The demyelination seen in CIDP impairs this process, resulting in motor impairment, numbness, difficulty walking, and general weakness and fatigue.

The immune response causing CIDP involves the activation of T cells as well as the expression of cytokines, tumor necrosis factor, interferons, and interleukins. Immunoglobulin and complement are also implicated in CIDP pathogenesis.

2. CIDP presentation can vary considerably.

Fifty to sixty percent of CIDP cases are so-called “typical,” presenting with symmetric symptoms of both proximal and distal limbs in which motor impairment is more prominent than sensory symptoms. A diagnosis requires that a patient’s symptoms have progressed gradually for at least 8 weeks, although some patients present with either acute or relapsing-remitting forms of the disease. While CIDP symptoms can usually be managed throughout life, long-term disability is not uncommon.

Some 20%-30% of CIDP cases are idiopathic, although it is frequently seen in conjunction with a variety of other illnesses, including HIV, diabetes, lupus, hepatitis, lymphatic cancer, and restless legs syndrome. It also may present as a comorbidity of infection or as a side effect of various cancer and HIV drugs.

CIDP can affect anyone but is most commonly diagnosed in individuals in their 50s and 60s and is twice as common in men. The global yearly incidence of the disorder is 1.5-3.6 million, with around 30,000 people affected in the United States at any given time. In patients with type 2 diabetes the incidence rises to over 26%.

3. A variety of tests can confirm a CIDP diagnosis.

Nerve conduction studies and electromyography are diagnostic standards in CIDP they; can reveal the demyelination and resulting slowed neuromuscular transmission characteristic of disease. Nerve biopsy can also be helpful, providing pathologic evidence of nerve damage and inflammation.

Often physicians will also order a lumbar puncture in suspected CIDP cases, looking for elevated spinal fluid protein without elevated white cells. In atypical cases, in which electrophysiologic tests may be inconclusive, MRI can help confirm a diagnosis. Blood tests may also be used to detect common comorbidities such as diabetes and lupus.

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**Comment**

And, Dr. Cameron has written how one woman with CIDP actually had Lyme disease:  https://danielcameronmd.com/chronic-inflammatory-demyelinating-polyneuropathy-cidp-case-resolved-antibiotics/

Excerpt:

Lyme disease has been ruled out in other conditions based on negative serologic tests only to seroconvert to positive serologies on follow-up. [1,2] This was demonstrated in the case of a 41-year-old woman with chronic inflammatory demyelinating polyneuropathy (CIDP), according to Perronne from the Infectious Diseases Unit, University Hospital Raymond Poincaré, APHP, Versailles Saint Quentin University, Garches, France.

The woman, who was then treated successfully with 6 weeks of doxycycline and hydroxychloroquine, showed “a dramatic clinical improvement” with a complete disappearance of neurologic signs, according to Perronne.

The authors advised against automatically ruling out Lyme disease based on negative serologic tests.

The woman presented with asthenia (loss of strength), weakness, and diffuse paresthesias (abnormal skin sensations). All of which are hallmark Lyme symptoms.

For more on CIDP:  https://30g7el1b4b1n28kgpr414nuu-wpengine.netdna-ssl.com/wp-content/uploads/2012/01/CIDP.pdf

A word of warning, however.  The pdf mentions the success of corticosteroids, but Lyme literate doctors have discovered this to be counter productive unless antimicrobials are used concurrently as catabolic steroids depress the immune system allowing the infection(s) to proliferate.  

Regarding treatment for CIDP, the pdf states that “up to eighty percent of CIDP patients respond to one or more therapies that modulate the immune system. Treatments shown to work in clinical trials include prescribing corticosteroids, blood plasma exchange or plasmapheresis, and intravenous immunoglobulin or IVIG. All three treatments are highly effective and lead to improved strength and function in CIDP patients. Each treatment has its advantages and disadvantages that should be discussed with the physician.”

If you’ve been diagnosed with CIDP but suspect tick borne illness, please share this with your medical practitioner.  Also, point out the initial seronegativity on Lyme tests by patients with CIDP who were found to seroconvert later.  

Category:

Lyme, research, Treatment

Study Shows Increase of Non-Lyme Tick-Borne Diseases

https://lymediseaseassociation.org/wp-content/uploads/2020/01/EL-Lyme-Article.pdf Study found here

https://lymediseaseassociation.org/news/study-shows-increase-of-non-lyme-tick-borne-diseases/

Study Shows Increase of Non-Lyme Tick-Borne Diseases

A study by Elizabeth Lee-Lewandrowski, PhD, MPH, et al, published in The American Journal of Clinical Pathology from the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, evaluated trends in non-Lyme disease tick-borne disease (NLTBI) blood testing at Quest Diagnostics laboratory located in New Jersey.

The study took place over the course of seven years and included polymerase chain reaction (PCR) and serological tests. Testing data from Quest Diagnostics were analyzed both nationally and at the state level from 2010 through 2016.

The study showed that:

  • testing and positivity for most NLTBIs increased dramatically over the course of the study,
  • testing criteria was not as stringent as required for public health reporting, but the study showed that the number of positive cases generally exceeds those reported by the Centers for Disease Control and Prevention (CDC),
  • frequency of NLTBI in US is seasonal but testing activity and positive test results are present throughout all months of the year, and
  • positive results for NLTBI testing originated primarily from a limited number of states, signifying a geographic concentration and distribution.

The study shows a significant increase in the number of reported cases of many NLTBI from 2004 to 2016, including a

  • 6.6-fold (875 to 5,750) increase in anaplasmosis and ehrlichiosis combined.
  • It also uncovered a significant underreporting of Lyme disease and Q fever to the CDC.
Since reporting for tick-borne illnesses (TBI) generally use the same reporting system as Lyme disease,  the researchers indicate the possibility that underreporting also occurs for other TBI.

The study outlines laboratory-developed tests (LDTs) that have not been cleared by the US Food and Drug Administration (FDA) but have been approved by Clinical Laboratory Improvement Amendments (CLIA) regulations.

Said LDA President Pat Smith,

“Although the findings are not surprising to many in the Lyme community, it is imperative that we have this data to support the increases in many of these non-Lyme tick-borne diseases. Increased awareness will result in medical professionals being more likely to consider other tick-borne diseases in people who have been bitten by ticks.”

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For more:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

Excerpt:

For the first time, Garg et al. show a 85% probability for multiple infectionsincluding not only tick-borne pathogens but also opportunistic microbes such as EBV and other viruses.

I’m thankful they included Bartonella as that one is often omitted but definitely a player.  I’m also thankful for the mention of viruses as they too are in the mix.  The mention of the persister form must be recognized as well as many out there deny its existence.

Key Quote:  “Our findings recognize that microbial infections in patients suffering from TBDs do not follow the one microbe, one disease Germ Theory as 65% of the TBD patients produce immune responses to various microbes.”

But there is another important point.

According to this review, 83% of all commercial tests focus only on Lyme (borrelia), despite the fact we are infected with more than one microbe.

https://madisonarealymesupportgroup.com/2017/05/01/co-infection-of-ticks-the-rule-rather-than-the-exception/

 

 

 

Category:

research

Is Prolonged Treatment For Lyme Disease The New Norm?

https://danielcameronmd.com/is-prolonged-treatment-for-lyme-disease-the-new-norm/

IS PROLONGED TREATMENT FOR LYME DISEASE THE NEW NORM?

The Infectious Diseases Society of America (IDSA) guidelines recommend a 3- to 4-week course of antibiotics for the treatment of Lyme disease. But a new study by the Centers for Disease Control and Prevention (CDC) indicates that nearly 2 out of every 3 patients with Lyme disease are treated longer than 4 weeks.

By

According to an annual, cross-sectional, nationwide survey,

  • 20.3% were treated for 5 to 8 weeks, while
  • 35.6% were treated for more than 8 weeks.
The CDC authors were surprised at the number of Lyme disease (LD) cases being treated with prolonged therapy.

“A surprisingly large proportion of respondents reported receiving more than 8 weeks of antibiotic treatment for LD,” writes Hook in the journal Ticks and Tick-borne Diseases.

Prolonged therapy for Lyme disease is not new. “Many respondents reporting receiving prolonged therapy is concordant with other reports of providers’ non-adherence to or unfamiliarity with LD treatment guidelines,” writes Hook.

The CDC authors were not able to address the rationale for extended treatment without having access to the attending physician or patient charts. Instead, they cited the familiar dogma regarding Lyme disease treatment.

  • “There is no scientific evidence of clinical benefit from antibiotic treatment longer than current guidelines recommend.”
  • “In patients with persistent symptoms and a history of LD, several controlled trials showed no benefit in prolonged antibiotic therapy.”

The authors postulate that prolonged therapy for Lyme disease could be stopped with education.

“Our results indicate that providers in LD endemic areas may benefit from education regarding the duration of therapy needed, especially in light of the risk of antibiotic-related complications and development of resistance.”

Editor’s note: I find that most doctors are well aware of the IDSA and CDC opposition to more than a 4-week course of antibiotics. The evidence behind the IDSA and CDC recommendations is flawed. I am an author of the International Lyme and Associated Diseases Society (ILADS) guidelines, which recommend prolonged therapy for Lyme disease if needed.

Related Articles:

Failure rates still too high for the treatment of Lyme disease

Over 20% of Lyme disease patients still remain ill after treatment

John Hopkins’ study supports early identification of Lyme disease patients for re-treatment

References:
  1. Hook SA, Nelson CA, Mead PS. U.S. public’s experience with ticks and tick-borne diseases: Results from national HealthStyles surveys. Ticks Tick Borne Dis. 2015 Jun;6(4):483-8.

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**Comment**

All I can say is “THANK GOD FOR ILADS!”

To understand the shady biased back story on why we are in the straits we are in:  https://madisonarealymesupportgroup.com/2019/02/22/why-mainstream-lyme-msids-research-remains-in-the-dark-ages/

Also worth noting are the severe conflicts of interest within the CDC, the very people making treatment guidelines:

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ConflictReport  Go to part III

I just posted this excellent article on the backstory of the Lymerix vaccine which also uncovers shady dealings, dishonesty, and conflicts of interest:  https://madisonarealymesupportgroup.com/2020/02/10/the-bitter-feud-over-lymerix/

 

Category:

Lyme, research, Treatment