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Department of Neurology, Division of Infectious Diseases, State University of New York, Stony Brook, NY (Dr. Halperin)
Department of Medicine, State University of New York, Stony Brook, NY (Dr. Luft)
Department of Radiology (Drs. Roque and Alvarez), Division of Allergy, Immunology, and Rheumatology, State University of New York, Stony Brook, NY
Department of Medicine, State University of New York, Stony Brook, NY (Drs. Volkman and Dattwyler)
Long Island Diagnostic Imaging, PC, Stony Brook, NY (Dr. Anand).
We evaluated 85 patients with serologic evidence of Borrelia burgdorferi infection. Manifestations included encephalopathy (41), neuropathy (27), meningitis (2), multiple sclerosis (MS) (6), and psychiatric disorders (3). We performed lumbar punctures in 53, brain MRI in 33, and evoked potentials (EPs) in 33. Only patients with an MS-like illness had abnormal EPs, elevated IgG index, and oligoclonal bands in the cerebrospinal fluid. Twelve of 18 patients with encephalopathy, meningitis, or focal CNS disease had evidence of intrathecal synthesis of anti-B burgdorferi antibody, compared with no patients with either MS-like or psychiatric illnesses, and only 2/24 patients with neuropathy. MRIs were abnormal in 7/17 patients with encephalopathy, 5/6 patients with an MS-like illness, and no others. We conclude that (1) intrathecal concentration of specific antibody is a useful marker of CNS B burgdorferi infection; (2) Lyme disease causes an encephalopathy, probably due to infection of the CNS; (3) MS patients with serum immunoreactivity against B burgdorferi lack evidence of CNS infection with this organism.
Address correspondence and reprint requests to Dr. Halperin, Dept. of Neurology, HSC T12-020, SUNY, Stony Brook, NY 11794.
Supported in part by a grant for Lyme Disease Research from the State of New York.
Received October 19, 1988. Accepted for publication in final form December 16, 1988.
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