Here are only a few ways that Lyme can affect the brain and physiologically diminish a person abilities.
Extreme Irritability and/or Emotional Lability
Many patients reported mood and behavioral changes during the course of their illness. In our sample, 64% of patients reported increased irritability and/or emotional lability in association with symptoms suggestive of meningeal irritation: neck stiffness and headache. The mood and behavior changes are often so severe and pervasive as to constitute a personality change. Sudden, intense irritability is most often triggered by sensory stimulation in patients who are acutely sensitive to sound, touch or light but may also occur unprovoked and seemingly inexplicably. One man, acutely sensitive to sound, was so intensely bothered by the noise his three-year-old son was making that he picked him up and shook him in a sudden and unprecedented fit of violence. His wife was shocked and alarmed by this behavior, as was the patient himself. A woman, typically reserved and eager to please, became uncontrollably irritable one day at work and found herself yelling at her boss in a most uncharacteristic fashion. Others have found themselves bursting into tears, sometimes several times a day, on what seems like very little provocation.
Word Reversals When Speaking and/or Letter Reversals When Writing
These odd, idiosyncratic but quite common symptoms were reported in 69% of our sample. Patients with no prior history of dyslexia have found themselves writing letters backwards, reversing numbers or routinely reversing the first and second letters of a word. One patient recalls also switching her shoes: putting the left shoe on the right foot and the right shoe on the left foot before she realized her mistake. This patient also experienced what might be understood as reversals in temporal sequencing: for instance, saying the word "tomorrow" when she meant "yesterday" and vice versa.
Spatial Disorientation
Reported in 57% of our sample. A not uncommon scenario is of a patient who, recalling no rash or flu-like symptoms, had experienced some aches and pains and/or memory problems but had not paid much attention to these symptoms until he found himself, on two consecutive days, lost in his own neighborhood, on his way home from work. Such a scenario suggests a disorder of topographic orientation and geographic memory such as may be seen among patients with parietal lobe dysfunction (45). Patients have reported other behaviors as well which seem to relate to disturbances of the body-environmental schemata. A young woman described repeatedly bumping into things on the left side of her body, dropping things from her left hand despite having no weakness in that hand and occasionally placing objects, such as a milk carton, several inches short of a table edge with the result that they would fall to the floor. These difficulties remitted completely following adequate antibiotic treatment.
Fluctuations in Symptoms
This can be one of the most frustrating and perplexing aspects of the illness. A patient with late-stage Lyme disease might feel totally drained one day, the next day be able to function almost normally and the day after experience such mental confusion as to be unable to focus on even the simplest of tasks. Sometimes the fluctuations may be brought on by exertion or stress or exposure to sensory stimuli or by the initiation of antibiotic treatment, but sometimes no explanation can be found. The fluctuations make it impossible for patients to make plans, and may make it seem to friends, teachers, family members or even the patients themselves as if the symptoms were somehow under voluntary control or as if they were hysterical in origin. Of course psychological factors, too, can influence symptomatology, but fluctuations are typical regardless of mental state.
Such vicissitudes raise a particular problem in children who may experience fluctuating cognitive impairments: short-term memory problems, word-finding difficulties, dyslexia, problems with calculations or inability to concentrate. School systems are by and large unaware of the cognitive aspects of late-stage Lyme disease and, in particular, of the ways in which cognitive impairments may fluctuate from day to day in a given child. Teachers may assume the child is just moody or uncooperative. Family dynamics, too, may be complicated by confused expectations of the sick member, and resentments may build when a person's functional status, mood and ability to participate in family life seem inexplicably erratic. Patients and family members alike find it difficult to have their hopes raised repeatedly by a transient clinical improvement, only to be slapped down again by a recrudescence of debilitating symptoms. Even with treatment, recovery from late-stage Lyme disease is most often a lengthy process involving significant fluctuations in symptoms even in the context of overall improvement.
Worsening of Symptoms During Antibiotic Treatment
Nearly half of the patients in our sample reported a transient worsening of neuropsychiatric symptoms during the first few days of antibiotic treatment. The worsening of symptoms during initiation of antibiotic treatment is thought to be a variant of the Herxheimer reaction as seen in the treatment of syphilis (33). In Lyme disease, however, this Herxheimer-like reaction can be quite prolonged-lasting a few days or longer-and can be frightening to patients who are expecting a resolution, not a worsening, of their symptoms. The reaction can sometimes be difficult to distinguish from an allergic reaction to the medicine, a distinction with obvious and crucial treatment implications.
This Herxheimer-like reaction may be experienced as a worsening of psychiatric symptoms: some patients in our sample experienced panic attacks for the first and only time when starting on antibiotics. Others have reported an intensification of depressive symptoms, suicidality or anxiety. Many reported an increased startle response and photophobia during the first few days of antibiotic treatment.
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