Association of small fiber neuropathy and post treatment Lyme disease syndrome, 2019, Novack et al

[Andy]

Abstract
Objectives
To examine whether post-treatment Lyme disease syndrome (PTLDS) defined by fatigue, cognitive complaints and widespread pain following the treatment of Lyme disease is associated with small fiber neuropathy (SFN) manifesting as autonomic and sensory dysfunction.

Methods
This single center, retrospective study evaluated subjects with PTLDS. Skin biopsies for assessment of epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD) and functional autonomic testing (deep breathing, Valsalva maneuver and tilt test) were performed to assess SFN, severity of dysautonomia and cerebral blood flow abnormalities. Heart rate, end tidal CO2, blood pressure, and cerebral blood flow velocity (CBFv) from middle cerebral artery using transcranial Doppler were monitored.

Results
10 participants, 5/5 women/men, age 51.3 ± 14.7 years, BMI 27.6 ± 7.3 were analyzed. All participants were positive for Lyme infection by CDC criteria. At least one skin biopsy was abnormal in all ten participants. Abnormal ENFD was found in 9 participants, abnormal SGNFD in 5 participants, and both abnormal ENFD and SGNFD were detected in 4 participants. Parasympathetic failure was found in 7 participants and mild or moderate sympathetic adrenergic failure in all participants. Abnormal total CBFv score was found in all ten participants. Low orthostatic CBFv was found in 7 participants, three additional participants had abnormally reduced supine CBFv.

Conclusions
SFN appears to be associated with PTLDS and may be responsible for certain sensory symptoms. In addition, dysautonomia related to SFN and abnormal CBFv also seem to be linked to PTLDS. Reduced orthostatic CBFv can be associated with cerebral hypoperfusion and may lead to cognitive dysfunction. Autonomic failure detected in PTLDS is mild to moderate. SFN evaluation may be useful in PTLDS.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212222

 

[duncan]

I had a younger brother who died from a nasty form of cancer. He tried all the standard treatments for the cancer, but he died from a combination of the cancer and treatments, regardless.

After he had undergone chemo and radiation therapy, and before they could test him to see if the cancer had been eradicated and/or returned, he continued to suffer. His symptoms were not labeled post-treatment Cancer syndrome. They were considered part of his cancer sequela.

Lyme disease testing is not as unambiguous as some Cancer tests. So no one can tell with certainty that a patient diagnosed with Lyme, and treated for Lyme, is free of Lyme. That is a fact.

So why would anyone presume to suggest that Lyme is not what is continuing to generate the same symptoms, more or less, as when the patient had been diagnosed with Lyme?

Many believe PTLDS is a political label, and has no place in either clinical or research settings, since it pretty much presumes conventional abx protocols will unfailingly cure the Lyme patient.

Accordingly, this paper seems to supply evidence that Lyme can cause SFN and OI despite administering a course of antibiotics.

 

[DokaGirl]

This study, (among others I would assume) indicates physical debilitation continues after antibiotics for Lyme disease. Let's get on with believing pwLD, and find better treatments!