Can Lyme Disease Mimic ALS? Motor Neuron Symptoms and Differential Diagnosis
Can Lyme disease mimic ALS? In some cases, patients with Lyme disease develop motor neuron symptoms that resemble ALS—making accurate diagnosis critical.
Because neurologic Lyme disease can affect the peripheral nerves, spinal cord, and cranial nerves, some patients may initially appear to have a motor neuron disorder.
Case Presentation
Wirsching and colleagues described a 63-year-old man who developed progressive neurologic symptoms ultimately meeting the criteria for probable ALS.
In the year prior to developing symptoms, the patient reportedly experienced a tick bite without a rash.
“In July 2018, that is, within six months, he developed paraparesis of both arms and also suffered from cramps in the shoulder girdle and hand muscles,” the authors wrote. “By August 2018, the patient was severely impaired in everyday life activities.”
The patient developed bilateral atrophic arm paresis with preserved reflexes and progressive weakness—findings concerning for motor neuron disease.
Motor neuron symptoms associated with Lyme disease may include weakness, muscle wasting, cramping, and progressive functional decline.
Diagnostic Testing
His spinal tap revealed pleocytosis (an elevated white count) and elevated protein levels. The spinal fluid was positive for IgM and IgG titers for Lyme disease, while blood testing was positive by ELISA and IgG Western blot.
The antibody index was higher in the spinal fluid than the blood for IgM but not IgG.
Patients with Lyme disease may also report fatigue, pain, sensory symptoms, cognitive complaints, or fluctuating neurologic findings that are less typical for classic ALS.
Patients with progressive weakness should be evaluated carefully because delayed diagnosis can affect both treatment decisions and prognosis.
Treatment and Outcome
The patient was treated with a three-week course of intravenous ceftriaxone, but his neurologic symptoms did not improve.
“Hence, it is unlikely that neuroborreliosis was the main cause of symptoms in our patient,” the authors wrote.
The authors ultimately concluded that the patient’s ALS mimicked Lyme disease rather than Lyme disease causing ALS.
Why Differential Diagnosis Matters
Another study suggested that Lyme disease should be considered in patients presenting with ALS. “There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi.” However, subsequent larger studies did not confirm a clear association.
Although the relationship between these diseases remains controversial, the authors emphasized the importance of excluding potentially treatable conditions during an ALS evaluation.
“It is vital to exclude potentially treatable diseases in the differential diagnostic work-up of all patients not to miss seldom, but treatable differential diagnoses such as neuroborreliosis,” the authors concluded.
Harvey and Martz also described a patient with motor neuron disease whose symptoms improved following antibiotic therapy.
Frequently Asked Questions
Can Lyme disease cause ALS-like symptoms?
Yes. Lyme disease can produce motor neuron symptoms that resemble ALS, including progressive weakness and muscle atrophy.
How can doctors differentiate between ALS and Lyme disease?
Testing may include spinal fluid analysis for Lyme antibodies along with blood testing and neurologic evaluation. Positive Lyme testing alone does not always establish causation.
Can ALS symptoms from Lyme disease improve?
Some patients with motor neuron symptoms have improved with antibiotic treatment, while others have not responded. Additional research is needed.
Related Reading
References
- Wirsching I, et al. ALS mimic by neuroborreliosis—case report and review of the literature. BMC Neurol. 2020.
- Harvey WT, Martz D. Motor neuron disease recovery associated with IV ceftriaxone and anti-Babesia therapy. Acta Neurol Scand. 2007.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I love the fact that this information is getting out. We lost our youngest brother to non genetic so called ALS. I had a Lyme diagnosis after 3years of running to specialists back in 1994. And it was a huge struggle to shake my MS original diagnosis. Then when our brother got diagnosis I pleaded with him to try antibiotics as they had just been to a high Lyme disease area. He obliged me and was improving but in the meantime seeing the ALS “specialists”, who discouraged him (and his wife) from continuing on with foolishness. Sadly, after stopping his antibiotic treatment, he rapidly decline. Passing away 2years later. If even 10% of ALS patients have been misdiagnosed, we’ll, in my opinion, that is huge! Thank you so much for sharing this information!
I am sorry for the loss of your youngest brother.
Are you doing ok know
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It amazes me that physicians do not know that antibiotics will do if Lyme has not been acquired recently. The positive tests were discarded because of the lack of this knowledge, and a patient who CLEARLY had Lyme disease was denied proper treatment (which is not three weeks of antibiotics.) I find this unconscionable and wonder why I know more about chronic Lyme than the doctor does. I hope the patient had the knowledge to see an LLMD.
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Hello I was diagnosed with Als on 09-21. I have weak legs and atrophy of arms and shoulders. I was bitten by a tick on 07-30-20. I tested positive 5 months ago with lymes 2 strains of Bartonella and babesa i also tested positive for mold. My white blood count is elevated. All neurologist I’ve seen insist I have Als yet I have other symptoms that do not go with Als. I’ve been this way for over 2yrs. Please I need real medicine aDr who actually wants to figure it out Ave help. I was given Als diagnosis after 6 days of testing. Other drs went off of test results from first dr.