Multiple Sclerosis and Lyme Disease
Accurate diagnosis of multiple sclerosis can be a challenge. One of the diseases that can present with neurologic symptoms similar to those seen in patients with MS is Lyme disease.
It may seem unusual for there to be similarities between Lyme disease, which is caused by bacteria known as Borrelia burgdorferi, a spirochete carried by deer ticks, and multiple sclerosis, whose exact cause is unknown. Multiple sclerosis likely is the result of interaction between immunology, genetics, and epidemiology, while some believe infectious agents may be involved.
Yet Lyme disease can present with MS-like symptoms, including blurry vision associated with optic neuritis, weakness, fatigue, dysesthesias (itching, stabbing or burning pain, tingling), cognitive problems, and confusion, In addition, magnetic resonance imaging (MRI) scans do frequently show lesions on the brain like those seen in MS.
Therefore, if someone is experiencing symptoms of multiple sclerosis, should he or she also be tested for Lyme disease? Perhaps.
Individuals who live in areas of the country where Lyme disease is prevalent (e.g., from Maine to northern Virginia, as well as Wisconsin, northern Minnesota, and northern Illinois) are at greatest risk of experiencing a tick bite that may transmit the organism and likely should be tested. However, this is a discussion individuals should have with their healthcare provider.
Distinguishing Lyme disease and MS
Making a distinction between Lyme disease and multiple sclerosis continues to be difficult. One way to determine if Lyme disease is in the picture is to undergo a blood test to identify the presence of antibodies to Borrelia. The cerebrospinal fluid (CSF) also may be used for such testing.
A drawback, however, is that testing for Borrelia antibodies is not always accurate among labs. One lab that has been shown to be reliable is IGeneX Lab in Palo Alto, California, but one should always consult with their doctor on testing matters.
Richard Horowitz, MD, author of Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease, has stated that “the lack of a reliable blood test, and the overlapping of symptoms between the two diseases, would explain the frequent number of patients who I see in my medical office who have been diagnosed with MS when, in fact, they have Lyme disease and MSIFD.”
MSIFD is multiple systemic infectious disease syndrome, a symptom complex that includes Lyme disease and multiple related tick-borne co-infections. One question concerning a link between Lyme disease and MS is whether the former and/or co-infections could stimulate an MS autoimmune reaction, which it can do with other inflammatory disorders.
According to a recent review appearing in JAMA Neurology, some of the differences between Lyme disease and multiple sclerosis that may help when making a diagnosis include white matter plaques. Brian Fallon, MD, MPH, Med, director, Lyme and Tick-Borne Diseases Research Center at Columbia University, has noted that the white matter in Lyme disease tends to be smaller than what is usually seen in MS.
The presence of oligoclonal bands in the cerebrospinal fluid can be seen in both MS and Lyme disease patients, yet when observed in the former, they are there as a reaction against B. burgdorferi. In addition, Fallon has explained that oligoclonal bands in the CSF of individuals with Lyme disease is not common, but they are in MS patients.
Some individuals might have a positive serologic test for Lyme disease and MRI indications of multiple sclerosis. When this occurs, physicians may consider antibiotic treatment to see if it has any impact on the lesions seen on the MRI scan.
The line between multiple sclerosis and Lyme disease has not been clearly drawn. It is important for individuals and their doctors to recognize the possible relationship between the two, that individuals can have multiple sclerosis and not Lyme disease, Lyme disease and not MS, and both together.
Fallon B. Columbia Psychiatry.
Horowitz RI. Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease. New York: St. Martin’s 2013.
Melia MT et al. Lyme disease: authentic imitator or wishful imitation? JAMA Neurology 2014 Oct; 71(10): 1209-10