Dr. Fallon; Columbia University on brain Lyme

  "This pleasant young man is 41 years old and he can't remember anything (slight exaggeration). He still works. But his loss of short term memory and bouts of confusion are driving everyone in his life crazy. He went to pick up his daughter, but went to the wrong school. He gets lost and confused. All of his critical cognitive processing has slowed down to a snail's pace. He looks like an early Alzheimer's patient. He is 41 years old!

    He had Lyme disease 11 years ago. His doctors prescribed 3 weeks of Doxycycline and told him he would DEFINITELY be cured. It could of been me. It wasn't. I saw him a year ago for typical chronic Lyme. I treated his with oral antibiotics. His aches and pains went away. His fatigue and other subjective symptoms all cleared up. After seeing me he sought the advice of a practitioner of alternative and complementary medicine. He was chelated for high mercury levels. He brain has gotten progressively worse.

  Today I sent him for blood studies. I ordered a Brain MRI with contrast and a nuclear medicine SPECT scan. He is going to need IV Rocephin and his insurance company will refuse to cover it for very long. Like similar patients,

his MRI will show various degrees of white matter changes in the deep part of the brain. If the radiologist is given a history of Lyme infection, he will report that these changes are compatible with Lyme disease. Otherwise the report will suggests such things as a demylinating process, IE MS, vascular disease of small blood vessels or changes related to migraine disorder.

The SPECT scan will show non-specific changes in blood flow to the brain which are compatible with Brain Lyme, but not specific.

His laboratory test will show various abnormalities.

The ELISA test for Lyme will be negative. The 10 band Western Blot test will probably be negative, but show one or two reactive bands.

The 28 band Western Blot from IgeneXwill likely be positive, but may only show indeterminate bands at the critical locations.

The CD57 count will likely be low. C4a and C3a complement levels will likely be elevated, but this is not guaranteed.

The C-reactive protein level may be high.

The vitamin D ratio will likely be abnormal. Vitamin D OH 25 will be low and Vitamin D 1,25 will be high, perhaps in the toxic range. This is the most reliably abnormal laboratory marker of the illness, yet there are no published studies which support this.

  Co-infection antibodies may be present, or not. High antibodies against Chlamydia pneumonia are very common.

  If the patient is sent for psychological testing it will show a variety of abnormalities. These tests are expensive, time consuming and generally not covered by insurance. As a practical matter they are generally not done. A simple mental status exam performed by the physician will show abnormalities if the disease is severe, as in the case described above."

    (Dr. Fallon; Columbia University;Oct '07)