March 10, 2016 | News | Living with MS

MS is unlikely to be Lyme disease

The constellation of symptoms seen in MS, such as vision problems (optic neuritis), muscle aches and nerve pain, can be mimicked by other conditions, which causes some people to question whether their multiple sclerosis may be something else. Among the chief suspects is Lyme disease, sometimes referred to as the “great imitator”, because the signs and symptoms can resemble other diseases.

Lyme disease was first described a half-century ago, but took its name from Old Lyme, Connecticut, where it was more fully characterized in the mid 1970s. The disease is caused by a type of bacteria (called Borrelia) that is transmitted by a tick (called Ixodes). The tick normally feeds off of animals, such as deer, field mice and birds, but will attach to people. Ticks burrow into the skin and feed off blood, but must remain attached for 1-2 days to transmit the Lyme disease bacterium.

The initial symptoms of infection are a characteristic red, raised mark on the skin that gradually expands to about 5 cm (2 inches) in diameter. The redness in the centre goes away first, leaving the appearance of a “target” on the skin. Early symptoms include fever, headache, malaise and muscle aches, as if you’re coming down with the flu. If the infection isn’t treated, about 1 in 10 people will develop neurological symptoms (a condition called neuroborreliosis), such as numbness, nerve pain or paralysis (especially in the face). Uncommon complications can include meningitis and optic neuritis. Magnetic resonance imaging (MRI) may show lesions in the brain that are similar to those seen in MS (Fernandez and colleagues. AJNR Am J Neuroradiol 1990;11:479-481).

To further complicate the picture, some researchers have speculated that Lyme disease may trigger the development of MS (Baranova and colleagues. Zh Nevrol Psikhiatr Im S S Korsakova 2012;112(2 Pt 2):64-58). However, this is unlikely because when the immune system reacts to Borrelia, it doesn’t then cross-react to myelin (Pohl-Koppe and colleagues. Cell Immunol 1999;194:118-123). What this means is that from the point of view of immune cells, the bacterial components (antigens) don’t resemble myelin, so the immune attack doesn’t broaden to create collateral damage. So the disease mechanisms of Lyme disease and MS are quite distinct.

In support of this is a recent study that looked at the distribution of Lyme disease across the U.S. and compared it to deaths due to neurological diseases, such as MS, Alzheimer’s disease, ALS (amyotrophic lateral sclerosis, or “Lou Gehrig’s disease”) and Parkinson’s disease (Forrester and colleagues. Emerg Infect Dis 2015;21:2036-2039). There was no geographic overlap between Lyme disease and MS, indicating that Lyme disease isn’t a cause of MS.

However, since Lyme disease and MS can appear to be similar, the question remains: is it possible that Lyme disease has been misdiagnosed as MS?

The simplest way to differentiate the two is to do a blood test to detect the presence of antibodies to Borrelia. The bacterium’s immune signature can change during the course of infection, so a two-step test (called ELISA and Western blot) is recommended (Wormser and colleagues. Clin Infect Dis 2006;43:1089-1134).

A Canadian study used two-step testing to look at people with MS in the province of New Brunswick, and the results were presented at last month’s meeting of the Americas Committee for Treatment & Research in Multiple Sclerosis (Webster and colleagues. ACTRIMS 2016; abstract). About two-thirds of the people in the study had relapsing-remitting MS, and one-third had progressive MS. Of the 90 people tested, none had antibodies to Borrelia, meaning that none of them had been infected. So none of these MS cases could have been Lyme disease.

Testing for Lyme disease has become very fashionable and various private labs (including online) offer this service. But buyer beware – test results can be highly inaccurate and unreliable. If you do want to be tested, arrange it through a healthcare professional, who will send your blood sample to an accredited facility (such as the National Microbiology Laboratory in Canada). If you do test positive, the standard treatment is with an antibiotic to clear up the infection. However, it’s important to note that a positive test doesn’t rule out MS – people with Lyme disease can develop MS, and people with MS can develop Lyme disease if they receive a tick bite.

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