Most chronic neurologic Lyme patients presented with mild encephalopathy consisting of memory loss, depression, sleep disturbance, irritability, and difficulty finding words. “They forgot names, missed appointments, or misplaced objects. To compensate they made daily lists. Ten patients had symptoms of depression, and three of them sought psychiatric help or received antidepressant medication. Eight patients had excessive daytime sleepiness and seven had extreme irritability. They became angry over circumstances that previously caused minor annoyance. Finally, five patients had subtle symptoms of a language disturbance, with difficulty finding words. 1
The researchers conducted a second study, reproducing the chronic manifestations in a case series of 18 patients who met strict criteria for Lyme encephalopathy.68 The most common symptoms were memory loss, minor depression, somnolence, headache, irritability, hearing loss/tinnitus, and neuropathy. They also found the chronic patients’ recovery differed depending on length of treatment. The 18 Lyme encephalopathy patients were treated twice as long as the chronic neurologic Lyme patients (one month vs. two weeks), and 50 percent had “greatly improved” on follow-up. Two (11 percent) were somewhat improved on follow-up. 2
“The depression associated with the earlier encephalitic phase of neurologic Lyme disease is characterized by marked irritability and mood lability. Later, in the setting of encephalopathy, the depression is often more mild, characterized primarily by anhedonia, low energy, hopelessness regarding the future, and a diminished sex drive.” 3
In this case, during an initial consult with a neuropsychologist, 7-year-old Susan was diagnosed with attention deficit disorder because she had problems focusing on school work. Yet, she lived in a Lyme endemic area and had an array of other symptoms including:
lethargy
irritability
forgetfulness
headaches
poor coordination
joint pain
word-finding difficulties
light and sound sensitivity
The first infant, a 4 1/2-week-old male, presented with a fever of 101.7, sleepiness and periodic irritability. His mother had been diagnosed with Lyme disease during her third trimester at 32 weeks’ gestation. She presented with an erythema migrans rash and was treated successfully with amoxicillin. 4
Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
Logigian EL, Kaplan RF, Steere AC. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. J Infect Dis. 1999;180(2):377-383.
Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703, viii.
Saetre K, Godhwani N, Maria M, et al. Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. J Pediatric Infect Dis Soc.
