Lyme disease triggers neuropathy in the legs
It is well-recognized that Lyme disease can cause neurologic symptoms, such as peripheral neuropathy when the infection goes untreated. Patients can experience muscle weakness and/or twitching, loss of sensation in parts of the body, numbness, tingling sensations, problems with balance and bladder control, and a feeling of dizziness or faintness. But now, new research indicates that femoral neuropathy may also be due to Lyme disease.
A case report by Lazaro and Butt, published in the International Medical Case Reports Journal, describes a 67-year-old patient with Lyme disease and femoral neuropathy.¹ This is believed to be the first reported case of isolated femoral neuropathy triggered by Lyme disease.
Femoral neuropathy, also referred to as femoral nerve dysfunction, involves a loss of movement or sensation in parts of the legs due to damage to the femoral nerve.
The patient, who lived in central New York, a region endemic for Lyme disease, developed a large erythema migrans (EM or bull’s-eye) rash on his chest, which lasted for 3 weeks, along with swelling of his left knee.
An IgG Western blot test for Lyme disease was positive, and he was treated with a 4-week course of doxycycline.
“Shortly after the completion of the doxycycline therapy, this patient began complaining of gait difficulties and frequent falls, as well as intermittent painful cramps in his right thigh.”
An electromyography (EMG) test, which measures muscle response or electrical activity when a nerve muscle is stimulated, indicated the patient had a femoral neuropathy.
READ MORE: Small fiber neuropathy in Lyme disease and COVID-19
“A year after the onset of the disease, and following an extensive course of physical therapy, this patient was able to return to his full-time work as an attendant in a local store,” writes Lazaro.
“We firmly believe that the femoral neuropathy and Lyme disease seen in this patient were causally related,” the authors conclude.
This patient’s femoral neuropathy could have developed into a multifocal neuropathy, which involves damage to 2 or more different nerve areas, if the antibiotic treatment had been delayed.
“… if not for a timely institution of antimicrobial therapy, [the femoral neuropathy] might have evolved into a more overt or disseminated infectious or parainfectious process, affecting both the peripheral and central nervous systems.”
The authors’ findings suggest that femoral neuropathy is “analogous to facial nerve palsy as a presenting symptom of Lyme disease without the overt involvement of other cranial or peripheral nerves.”
The list of peripheral neuromuscular segments affected in Lyme disease has grown to include the nerve cell bodies and their axons, all of the cranial nerves except the olfactory nerve, the nerve roots, the brachial and lumbosacral plexuses, and the peripheral nerves, either in isolation or as part of a multiple or diffuse neuropathic process.²-³
Related Articles:
Autonomic dysfunction, small fiber neuropathy and Lyme disease
Chronic inflammatory demyelinating polyneuropathy case resolved with antibiotics
References:
- Lazaro RP, Butt K. Femoral mononeuropathy in Lyme disease: a case report. Int Med Case Rep J. 31 July 2019, Pages 243-247.
- Halperin JJ. Lyme disease and the peripheral nervous system. Muscle Nerve. 2003;28:133–147.
- Logigian EL. Peripheral nervous system Lyme borreliosis. Semin Neurol. 1997;17:25–29.
Kim
08/19/2024 (6:30 am)
Hi, I was diagnosed with late stage (chronic?) Lyme and Bart in 2020, along with reactivated EBV and mold. Still on treatment, but no antibiotics since 2022. I suffered a mild hip injury in Oct 2023, but it didn’t really disrupt my life so I didn’t see a doctor. Shortly after getting Covid in July 2024 I suddenly have a lot of intermittent nerve pain down my leg, especially deep in my thigh/hip area. Maybe the femoral nerve or piriformis muscle compressing sciatic nerve(?) Do you think it’s possible that Covid caused the Lyme/spirochetes to come out of hiding and affect the nerves in my thigh/hip area? I’ve heard spirochetes love scar tissue (from previous hip injury). If it’s possible, do you think I should talk to my LLMD about going on short-course antibiotic(s)? Thank you!
Dr. Daniel Cameron
08/19/2024 (6:40 am)
I have patients whose Lyme disease flareup from various illnesses including COVID but an not sure the cause
Jason Dardano
07/12/2024 (2:41 pm)
I have been having neurological symptoms since 5/23 after a 4 day backpacking trip in the Adirondacks. no EM, no obvious ticks on my person. I have been having whole body fasciculations, muscle spasms, and joint pain. My Lyme test came back inconclusive. I was given 21 days of Doxy, the symptoms subsided for 8 months, I was placed on an additional 7 days of doxy. Symptoms came back in March of this year. I have had NCS, EEG, EMG, Head/ spine MRI. They have r/o all major neuromuscular possibilities. On a whim, I asked for a CD8-CD57 test which was ‘LOW”. I have found that this occurs in neurologic Lyme. I live in Las Vegas and can not get a single ID physician to see me. Everyone states if my Lyme test is +/- or inconclusive, I do not have lyme and I do not need to be seen. When asked about how Doxy seemed to work initially (and for 8 months) and why I have a low CD8-CD57, they all respond ” I don’t know what the correlation is. I could use some help and potentially some medical tourism to rule this out.
Dr. Daniel Cameron
07/13/2024 (6:13 am)
I am sorry to hear you have been ill. I wish the Lyme disease and tests for co-infections were more reliable. I also wish a single 3 4o 4 week course of antibiotics would be more effective. I advise my patients with a negative or borderline test to rule out other illnesses as you have done. If my patient is still ill, I have patients who have done well with retreatment of Lyme disease or treatment for a tick-borne co-infection like Babesia.
Jim
06/01/2023 (8:15 pm)
Hi. I’m a New Zealander. My wife and I had a married daughter living in Sag Harbor (North Haven) Long Island. We traveled to visit her and our grandchildren frequently. Despite her caution re deer ticks (nightly inspections), in 2008 we returned to Christchurch, and I discovered a live tick attached to my inner thigh. Shortly after I experienced tingly prickly sensations in firstly my right foot, and eventually both feet. After several tests, I was diagnosed with idiopathic peripheral neuropathy. I’ve lived with the condition ever since, and never thought about Lyme until recently when my granddaughter (who was diagnosed with Lyme) has been suffering several related illnesses. I’ve used Gabapentin for 14 years until I recently reached the max dose of 12 tabs daily. I’ve now changed to Pregabalin. Finally, I’m 76, I’m clumsy on my feet (can’t walk in a straight line) and I’ve accepted that its a condition that I’ll have until I die.
Dr. Daniel Cameron
06/02/2023 (7:45 am)
Great question. One of many unanswered questions.
lynn
11/03/2022 (2:44 pm)
Was diagnosed with a positive lyme test in 2015. did a series of different antibiotics for several months that included doxy and erythromycin-cant remember the others. couple months after that, had another lyme test and this time it ended up indeterminate because a negative borrelia result could not be established. three years later, started having numbness in both arms and my legs. went to see a neurologist and had tests done to confirm a damaged nerve plus was diagnosed with peripheral neuropathy along with lupus. vit b12 levels were low so started taking that which really helped. low levels of vit d needs to be checked too. lyme and antibiotics can wreck havoc on a persons stomach and i think that contributes to not being able to absorb nutrients as needed, hence low levels. eating cabbage, sauerkraut and juice helped my stomach. hope my experience helps someone out there. lyme is very serious stuff