Could cytokine storms lead to brain fog in Lyme disease patients?


Lyme disease and COVID-19 patients often complain of having ‘brain fog.’ In a recent study, Remsik and colleagues suggest that brain fog reported by COVID-19 patients may be due to cytokines rather than an infection with the coronavirus SARS-CoV-2.

In their article, published in the journal Cancer Cell,¹ the authors explain, “One of the dozens of unusual symptoms that have emerged in COVID-19 patients is a condition that’s informally called ‘COVID brain’ or ‘brain fog.’ It’s characterized by confusion, headaches, and loss of short-term memory. In severe cases, it can lead to psychosis and even seizures.” Could cytokine storms lead to brain fog in Lyme disease patients?

The authors expected to find evidence of COVID-19 infection in the cerebral spinal fluid (CSF) of 13 patients hospitalized with COVID-19. They did not.

Instead, Remsik and colleagues found an elevation of cytokines in the spinal fluid of their COVID-19 patients with brain fog. According to the authors, “These patients had persistent inflammation and high levels of cytokines in their cerebrospinal fluid, which explained the symptoms they were having.”

“These increased CSF cytokines are likely the result of both increased blood barrier permeability and local production by cells in the CNS,” the authors write.

Investigators have previously raised concerns that Lyme disease spirochetes could cross the blood-brain barrier leading to brain fog. In his article, Dr. Robert Bransfield raised concerns that persisting immune activation causes a cytokine storm in patients with chronic Lyme disease.²

Remsik et al. add support to the role of cytokines in patients with brain fog, leading to the question: Are cytokine storms associated with brain fog in Lyme disease patients?

  1. Remsik J, Wilcox JA, Babady NE, et al. Inflammatory Leptomeningeal Cytokines Mediate COVID-19 Neurologic Symptoms in Cancer Patients. Cancer Cell. Feb 8 2021;39(2):276-283 e3. doi:10.1016/j.ccell.2021.01.007
  2. Bransfield RC. The psychoimmunology of lyme/tick-borne diseases and its association with neuropsychiatric symptoms. Open Neurol J. 2012;6:88-93. doi:10.2174/1874205X01206010088

3 Replies to "Could cytokine storms lead to brain fog in Lyme disease patients?"

  • Jennifer
    06/30/2022 (11:25 am)

    I have become very interested in this topic recently myself. I was diagnosed with Lyme disease in 2019 when it was already late stage with neuro & joint involvement. Brain fog, dizziness & bouts of complete loss of spatial orientation have been some of my worst challenges, which seems to come and go in flares and worsened with Herxing. Strangely enough, out of all the treatments I have tried, the most effective has been Hydroxychloroquine. I have often wondered why anti-malarials are the most effective treatments for me when Lyme is a bacterial infection. Recently I learned online that Hydroxychloroquine actually can help reduce production of pro-inflammatory cytokines. Which has led me to wonder if cytokine suppressants could be an effective way of controlling flares? What do you think Dr. Cameron? Would it be worth it to try a cytokine suppressant? And would there be any side effects or other drug interactions?

    • Dr. Daniel Cameron
      07/01/2022 (6:52 am)

      I have some patients who benefit from hydroxychloroquine treatment. I am not sure if it is a cytokine effect. I would typically look at atovaquone in my patients in case the parasite Babesia is the issue. I am not familiar with the cytokine suppressant field to comment.

    • Ray
      11/28/2023 (3:51 am)

      Hi I have had the same experience. Are your symptoms resolved?

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