Chronic Post-Concussion Syndrome Symptoms Due to Lyme Disease

Chronic post-concussion syndrome symptoms due to Lyme disease may be an underrecognized cause of persistent neurologic complaints. Researchers at the Azzolino Clinic in San Francisco identified what they describe as “an alarming number of individuals suffering from post-concussion syndrome (PCS) that are refractory to care and that have serologically tested positive for Lyme disease.”

“Furthermore, we have witnessed a dramatic improvement in function and reduction in disability following treatment of these patients,”
writes Azzolino and colleagues.

Why Consider Lyme Disease in Chronic PCS?

These findings raise an important question: could persistent symptoms in some patients reflect undiagnosed Lyme disease symptoms rather than ongoing brain injury alone?

The authors specifically asked whether ongoing symptoms could be explained by “an undiagnosed and untreated Lyme disease or associated co-infection.”

Study Design and Inclusion Criteria

The authors identified 217 patients with chronic PCS who had not responded to standard treatment for traumatic brain injury and who tested positive for Lyme disease by IgM Western blot through IGeneX laboratory testing.

To be included, patients had to have at least one PCS symptom—such as headache, irritability, dizziness, vertigo, or difficulty concentrating—for more than one year after injury, along with a normal brain CT or MRI scan.

Patients were excluded if they had prior Lyme disease or co-infections, had received at least two weeks of antibiotics after injury, or had alternative neurologic diagnoses such as multiple sclerosis, seizure disorder, or post-stroke syndrome.

[bctt tweet=”Study examines the prevalence of Lyme disease in patients with post-concussion syndrome who do not respond to treatment.” username=”DrDanielCameron”]

Key Findings

Among the 217 patients studied, 38% had a positive IGeneX IgM Western blot for Lyme disease.

“There was a statistically significant relationship of a positive Western blot IGeneX IgM predicting chronic PCS,” Azzolino writes.

The authors suggest that antibiotic treatment for Lyme disease “could also alleviate symptoms such as cognitive disturbances, dizziness, and fatigue.”

These symptoms overlap with both PCS and Lyme disease and co-infections, which may complicate diagnosis.

They further note that, “Given the cost of interventions for PCS, the diagnosis and treatment of co-morbid infections could prove to have a significant impact on the standard of care.”

Important Limitations

Editor’s note:
This study is limited by its reliance on an IgM Western blot from IGeneX laboratory and the absence of confirmatory IgG Western blot testing. The findings require further replication and validation.

Nevertheless, the study raises important questions about whether persistent symptoms in some patients diagnosed with post-concussion syndrome may reflect an underlying, potentially treatable infectious process.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

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