Selected Abstracts & Articles
MS & Lyme Disease
Part 1
Zh Nevrol Psikhiatr Im S S Korsakova. 2011;111(7):8-12.
[Differential aspects of multiple sclerosis and chronic borrelial encephalomyelitis].
[Article in Russian]
Spirin NN, Baranova NS, Fadeeva OA, Shipova EG, Stepanov IO.
Abstract
The Yaroslavl region is an endemic area for Lyme disease (LD) with one of the highest levels of morbidity in Russia. Chronic neuroborreliosis can mimic multiple sclerosis and cause considerable difficulties in differential diagnosis. A comparative clinical-instrumental analysis of patients with definite multiple sclerosis (n=65) and chronic borrelial encephalomyelitis (n=11) was carried out.
The key differential-diagnostic features of multiple sclerosis and borrelial encephalomyelitis were specified. Migrating erythema and tick's bite in the anamnesis, combined with lesions of the central and peripheral nervous systems, the absence of retrobulbar neuritis in the anamnesis, artralgia and myalgia, the high blood sedimentation rate were not characteristic of multiple sclerosis.
A patient with abovementioned findings should be tested for the presence of antibodies to Borrelia burgdorferi in the blood serum and, if necessary, in the cerebrospinal fluid to exclude the diagnosis of Lime disease.
PMID: 21947065 [PubMed - indexed for MEDLINE]
Zh Nevrol Psikhiatr Im S S Korsakova. 2012;112(2 Pt 2):64-8.
[Lyme disease in patients with multiple sclerosis: clinical, diagnostic and therapeutic features].
[Article in Russian]
Baranova NS, Spirin NN, Fadeeva OA, Shipova EG, Stepanov IO.
Abstract
Lyme disease is one of the most frequent infections in the Russian Federation. In patients with multiple sclerosis, the Borrelia infection may act as a trigger in some cases and also worsens the clinical course of multiple sclerosis. One hundred patients with definite multiple sclerosis were examined including 19 patients with the combination of multiple sclerosis and Lyme disease. The difficulties of diagnosis, clinical features and treatment of Lyme disease in patients with multiple sclerosis are discussed.
PMID: 22677681 [PubMed - indexed for MEDLINE]
Zh Nevrol Psikhiatr Im S S Korsakova. 2012;112(9 Pt 2):34-9.
[Differential diagnosis of late-stage neuroborreliosis with affection of the central nervous system].
[Article in Russian]
Spirin NN, Baranova NS, Fadeeva OA, Pakhomova IuA, Stepanov IO, Shipova EG, Kasatkin DS, Spirina NN.
Abstract
Chronic neuroborreliosis is an actual problem in neurology due to its under-investigation in Russia, variety of clinical forms, and the absence of well established diagnostic criteria. We present clinical and laboratory differential diagnostic criteria of chronic borrelial encephalomyelitis in comparison with multiple sclerosis.
Distinguishing characteristics of Lyme encephalopathy versus vascular encephalopathy are considered. Problems and possibilities of immunological methods for identification of B. burgdorferi are discussed. The results of the antibiotic treatment of different clinical forms of neuroborreliosis with affection of the central nervous system are described.
PMID: 23235422 [PubMed - indexed for MEDLINE]
Med Hypotheses. 2007;69(1):117-9. Epub 2007 Jan 2.
Lyme borreliosis and multiple sclerosis are associated with primary effusion lymphoma.
Batinac T1, Petranovic D, Zamolo G, Petranovic D, Ruzic A.
1Department of Dermatovenerology, Rijeka University Hospital, Kresimirova 42, 51000 Rijeka, Croatia.
Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by chronic inflammation and demyelination. Studies suggested that the viral, especially Epstein-Barr virus infection, and bacterial infections, especially Borrelia burgdorferi infection, play a role in etiology of MS. MS prevalence parallels the distribution of the Lyme disease pathogen B. burgdorferi.
Criteria used for diagnosis of MS can also be fulfilled in other conditions such as Lyme disease, a multisystem disorder resulting from infection by the tick-borne spirochete, B. burgdorferi. In the late period of Lyme disease demyelinating involvement of central nervous system can develop and MS can be erroneously diagnosed.
A Lyme borreliosis can mimick central nervous system lymphoma. Also, B. burgdorferi has been implicated not only in etiology of MS, but also in etiology of lymphoma. Studies suggested that there is an increased risk of non-Hodgkin lymphoma in patients, who had a history of autoimmune diseases such as MS and that both non-Hodgkin's lymphomas and Hodgkin's disease were associated with Epstein-Barr virus infection.
A small group of lymphomas called primary effusion lymphomas (PEL) is a recently individualized form of non-Hodgkin's lymphoma (WHO classification) that exhibit exclusive or dominant involvement of serous cavities, without a detectable solid tumor mass.
These lymphomas have also been linked to Epstein-Barr virus and human herpes virus type 8 infections but virus negative cases have been described. Therefore, we propose that MS and neuroborreliosis are linked to central nervous system primary effusion lymphomas. As a first step in confirming or refuting our hypotheses, we suggest a thorough study of CSF in the patients suspected for the diagnosis of MS and Lyme borreliosis.
PMID: 17197115 [PubMed - indexed for MEDLINE]
Neurology. 2013 Sep 10;81(11):1012-4. doi: 10.1212/WNL.0b013e3182a43b66. Epub 2013 Jul 26.
Neuroborreliosis during natalizumab treatment in multiple sclerosis.
Thomas K1, Schultheiss T, Ziemssen T.
1From the MS Center, Center of Clinical Neuroscience, Neurological University Clinic Dresden, University Clinic Carl Gustav Carus Dresden, University of Technology Dresden, Germany.
Abstract
We present a case of acute neuroborreliosis in the setting of long-term treatment with natalizumab. A 33-year-old man was diagnosed with relapsing-remitting multiple sclerosis (MS) in 1999. Following failure of various immunomodulatory treatments including interferon and immunoglobulin, he was treated with mitoxantrone from May 2000 to August 2004.
Due to persistently high disease activity, he was also treated with cyclophosphamide (December 2005-April 2006) and then azathioprine (April-June 2006), which were both discontinued due to adverse effects. After the patient scored 6.5 on the Expanded Disability Status Scale and had 2 relapses in 2006, we initiated natalizumab therapy (300 mg monthly, starting September 2006). The patient improved significantly in ambulation and the relapse rate slowed as well.
PMID: 23892705 [PubMed - indexed for MEDLINE]
Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28.
Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders.
1Department of Pediatric Neurology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
Abstract
The spectra of white matter neuroinflammatory diseases and pathological processes inducing inflammatory lesions in the white matter of the central nervous system are wider in children than in adults. The definitions of multiple sclerosis (MS) and of the related clinically isolated syndromes (CIS) and acute disseminated encephalomyelitis (ADEM) have been recently revised leading to a new consensus definition.
However, other entities with similarities to these diseases may also develop with monophasic or relapsing white matter inflammation. These conditions include congenital immunogenetic diseases (such as hemophagocytic lymphohistiocytosis), vasculitis, and autoantibody-mediated encephalopathies (Hashimoto encephalopathy, encephalitis with anti-N-methyl-D-aspartate receptor antibodies and neuromyelitis optica).
Moreover, infectious diseases, such as Lyme disease, tumors (oligodendroglioma and lymphoma), and even genetic or metabolic diseases should also be considered if the clinical course of the disease does not follow the typical pattern for ADEM or MS. This short review describes these different entities and provides information for the differential diagnosis of inflammatory diseases of the white matter.
Neuropediatrics. 2013 Dec;44(6):302-8. doi: 10.1055/s-0033-1358599. Epub 2013 Oct 28.
Rare inflammatory diseases of the white matter and mimics of multiple sclerosis and related disorders.
Abstract
The spectra of white matter neuroinflammatory diseases and pathological processes inducing inflammatory lesions in the white matter of the central nervous system are wider in children than in adults.
The definitions of multiple sclerosis (MS) and of the related clinically isolated syndromes (CIS) and acute disseminated encephalomyelitis (ADEM) have been recently revised leading to a new consensus definition. However, other entities with similarities to these diseases may also develop with monophasic or relapsing white matter inflammation.
These conditions include congenital immunogenetic diseases (such as hemophagocytic lymphohistiocytosis), vasculitis, and autoantibody-mediated encephalopathies (Hashimoto encephalopathy, encephalitis with anti-N-methyl-D-aspartate receptor antibodies and neuromyelitis optica).
Moreover, infectious diseases, such as Lyme disease, tumors (oligodendroglioma and lymphoma), and even genetic or metabolic diseases should also be considered if the clinical course of the disease does not follow the typical pattern for ADEM or MS. This short review describes these different entities and provides information for the differential diagnosis of inflammatory diseases of the white matter.
Georg Thieme Verlag KG Stuttgart · New York.
PMID: 24166147 [PubMed - in process]
AJNR Am J Neuroradiol. 2009 Jun;30(6):1079-87. doi: 10.3174/ajnr.A1579. Epub 2009 Apr 3.
Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis.
Hildenbrand P1, Craven DE, Jones R, Nemeskal P.
1Department of Radiology, Lahey Clinic Medical Center, Burlington, MA 01805, USA. Hildenbrand@lahey.org
Abstract
Lyme disease has a worldwide distribution and is the most common vector-borne disease in the United States. Incidence, clinical manifestations, and presentations vary by geography, season, and recreational habits. Lymeneuroborreliosis (LNB) is neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi in the United States and by Borrelia garinii or Borrelia afzelii species in Europe.
Enhanced awareness of the clinical presentation of Lyme disease allows inclusion of LNB in the imaging differential diagnosis of facial neuritis, multiple enhancing cranial nerves, enhancing noncompressive radiculitis, and pediatric leptomeningitis with white matter hyperintensities on MR imaging.
The MR imaging white matter appearance of successfully treated LNB and multiple sclerosis display sufficient similarity to suggest a common autoimmune pathogenesis for both. This review highlights differences in the epidemiology, clinical manifestations, diagnosis, and management of Lyme disease in the United States, Europe, and Asia, with an emphasis on neurologic manifestations and neuroimaging.
Neurology. 2013 Sep 10;81(11):1012-4. doi: 10.1212/WNL.0b013e3182a43b66. Epub 2013 Jul 26.
Neuroborreliosis during natalizumab treatment in multiple sclerosis.
Thomas K, Schultheiss T, Ziemssen T.
Abstract
We present a case of acute neuroborreliosis in the setting of long-term treatment with natalizumab. A 33-year-old man was diagnosed with relapsing-remitting multiple sclerosis (MS) in 1999. Following failure of various immunomodulatory treatments including interferon and immunoglobulin, he was treated with mitoxantrone from May 2000 to August 2004.
Due to persistently high disease activity, he was also treated with cyclophosphamide (December 2005-April 2006) and then azathioprine (April-June 2006), which were both discontinued due to adverse effects. After the patient scored 6.5 on the Expanded Disability Status Scale and had 2 relapses in 2006, we initiated natalizumab therapy (300 mg monthly, starting September 2006). The patient improved significantly in ambulation and the relapse rate slowed as well.
Acta Neurol Scand. 2011 Jun;123(6):396-9. doi: 10.1111/j.1600-0404.2010.01411.x.
Multiple sclerosis in Vest-Agder County, Norway.
Vatne A, Mygland A, Ljøstad U.
Abstract
OBJECTIVE:
To examine multiple sclerosis (MS) prevalence, rate of immunomodulatory treatment and frequency of Borrelia burgordorferi (Bb) antibodies in Vest-Agder, Norway.
MATERIALS AND METHODS:
Patients in the period 1996-2006 who met the Poser criteria for definitive or probable MS were included. Clinical and demographical data, and presence of Bb antibodies were registered.
RESULTS:
A total of 295 patients were identified. The crude prevalence was 180 per 100,000 population (95% CI=160.9-218.0), age-adjusted prevalence was 186 per 100,000 population (95% CI=166.3-225.3). The age-adjusted incidence rates were 7.5 and 8.0 for 1996-2000 and 2001-2006, respectively. Thirty-eight per cent were treated with immunomodulatory agents when compared to 28% in the rest of the country. Bb serum antibodies were detected in 7% of patients with MS.
CONCLUSIONS:
Vest-Agder county has the highest prevalence of MS reported in Norway, and a high treatment rate. Bb antibodies were not more prevalent than in healthy individuals.
Clin Neurol Neurosurg. 2010 Sep;112(7):625-8. doi: 10. 1016/ j.clineuro. 2010. 04. 011. Epub 2010 May 2.
Rare infections mimicking MS.
1University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Department of Neurology and Refferal Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia. vesna.brinar@zg.t-com.hr
Abstract
The diagnosis of multiple sclerosis (MS), despite well defined clinical criteria is not always simple. On many occasions it is difficult to differentiate MS from various non-MS idiopathic demyelinating disorders, specific and infectious inflammatory diseases or non-inflammatory demyelinating diseases. Clinicians should be aware of various clinical and MRI "red flags" that may point to the other diagnosis and demand further diagnostic evaluation.
It is generally accepted that atypical clinical symptoms or atypical neuroimaging signs determine necessity for broad differential diagnostic work up. Of the infectious diseases that are most commonly mistaken for MS the clinician should take into account Whipple's disease, Lyme disease, Syphilis, HIV/AIDS, Brucellosis, HHV-6 infection, Hepatitis C, Mycoplasma and Creutzfeld-Jacob disease, among others.
Cat scratch disease caused by Bartonella hensellae, Mediterranean spotted fever caused by Riketssia connore and Leptospirosis caused by different Leptospira serovars rarely cause focal neurological deficit and demyelinating MRI changes similar to MS. When atypical clinical and neuroimaging presentations are present, serology on rare infectious diseases that may mimic MS may be warranted. This review will focus on the infectious diseases mimicking MS with presentation of rare illustrative cases.
CONTINUED- 3 more parts.