This is avery good article because it mentions different presentations of Lyme.
It is very long, 24pgs. but I want to type just a few things from it that
are important.
From Brain (1992), 115, 399-423
The Clinical and Epidemiological Profile of Lyme Neuroborreliosis in
Denmark 1985-1990
  A prospective study of 187 patients with Borrelia burgdorferi specific
intrathecal antibody production
by Klaus Hanson and Anne-Mette Lebech  (from the Borrelia Laboratory,
Department of Infection-Immunology, Statens Seruminstitut, Copenhagen, Denmark)

from page 406:  "Painful sensory radiculitis:  
   " Radiculitic pain was a major symptom and present in 160
patients....The intensity of radicular pain increased significantly with
the age of the individual..The onset was in most instances subacute,
occurring overnight.  Pain often began in the region of a previous erythema
migrans, then migrated and finally became most pronounced axially in the
back typically between the shoulder blades but also in the neck or lumbar
region.  Some patients had migrating pain almost over the whole body.  The
pain was described as being of a type never experienced before and was
easily distinguished from ordinary back pains."(Alan Barbour's novel says
that Lyme doesn't cause back pain) "The intensity of the pain often varied
from day to day and typically showed severe nocturnal exacerbations
......Pain was described by most patients as severe, burning deep and/or
superficial as if located in the skin, and often accompanied by patchy
areas of unpleasant hyper- and dysaesthesiae .   Occasionally a belt-like
sensation around the trunk was described.  Severe pain was refractory to
morphine.  Forty-six patients had radiculitic pain only and never developed
focal motor signs.  In 54 patients the sensory radiculitis either
diminished or disappeared even before therapy after 2-16 weeks." (in my
experience it recurs later in the disease)
    "Before the final diagnosis of neuroborreliosis was established, the
painful condition was often thought to be due to other diseases, e.g.herpes
zoster neuralgia, cervical or lumbar nerve root compression, facet
syndrome, brachial plexus neuropathy, polymyalgia rheumatica, myocardial
infarction or kidney concrements (stones).  In one female a cholesystectomy
(gall bladder removal) was performed , three patients wunderwent biopsy of
the temp{*filter*}lobe , three and i.v. pyelogram (radiograph of the ureter and
renal pelvis), seven a bone scintigraphy and 17 a myelogram , before the
final diagnosis .  Routine examination of the CSF obtained during the
myelography unexpectedly revealed pleocytosis leading to the correct diagnosis.
   " Some patients presented with an agitated mental state.  This was
probably due to severe pain condition and deprivation of sleep for days to
weeks.  Thir{*filter*} patients were initially suspected of being hysterical and
several were examined by a psychiatrist because of the apparent
diproportion between thier dramatic complaints and the lack of signs of the
disease.
....Two had paresis of the abdominal wall.  The distribution of paretic
muscles usually indicated involvement of multiple nerve roots.  Tendon
reflexes were attenuated or absent only corresponding to the muscle
weakness.........spastic bladder paresis.....clinical signs of meningitis
are  remarkably rare....
    "We conclude that neuroborreliosis is a common, clinically
characteristic but still underrecognized neurological syndrome.
.....differential diagnosis:  Guillain-Barre syndrome, herpes zoster
radiculitis, lymphocytic meningitis of other aetiologies, meningeal
carcinomatosis (widespread dissemination of carcinoma in the body), CNS
lymphoma, sarcoidosis, multiple sclerosis and other encephalopathies."

I have noticed in the news lately that there is a move to control pain
medication and antibiotics.   The doctors involved in this push to have
government control of these {*filter*}, not only don't want to treat the Lyme
disease, they now want to take away any possible relief of the excruciating
pain syndromes some Lyme patients have.  I have been fortunate in the pain
area but have seen many people that haven't been so fortunate.  I have
never seen people suffer such pain.  Dr. Kevorkian should get ready for an
influx of customers if this push succeeds.

georgia

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