In Germany, there is a diffuse fear of (Neuro)Lyme disease, a disease transmitted by the bacterium Borrelia burgdorferi, which lives in the digestive tract of ticks. Lyme disease is considered a “mysterious” disease, supposedly responsible for a multitude of disorders. Not a few patients therefore believe that Lyme disease has been overlooked in their case – a fear that is also widespread among many MS patients.
The facts are different. In Germany, there are actually areas where up to a quarter of all ticks harbor borrelia in their digestive tract. For transmission to humans, the bacterium must migrate from the tick’s digestive tract to the human skin after a tick bite, which can take up to 12 hours. That’s why it is important to thoroughly check yourself after exposure and remove ticks quickly and gently from the skin (best with a tick pliers). This is the most effective protection against infection.
If transmission has occurred, the infection often runs clinically inapparent, i.e., the immune system copes with the pathogen and eliminates it without consequence. Studies on healthy blood donors show that about 10% of the normal population have dealt with borrelia – in the rarest cases, this has led to obvious infectious diseases. However, when it does occur, it usually (> 90%) manifests as so-called migratory redness (Erythema chronicum migrans, ECM), a skin redness that spreads centrifugally around the tick bite. This is treated with an antibiotic in tablet form and heals without consequences, because borellia are very sensitive to antibiotics.
In rare cases (about 5%), the nervous system can be affected by a borrelia infection. Such neuroborreliosis has a relatively typical clinical presentation – it is usually paralysis of a facial nerve or involvement of the spinal nerve roots, a painful symptomatology that reminds of a herniated disc. Neurologists know this clinical picture under the name Bannwarth syndrome, which can be clearly distinguished from relapse symptoms of MS. The Bannwarth syndrome also responds well to antibiotics, because borrelia are – as already mentioned – very sensitive to antibiotics.
In very rare cases (< 0.3%) – especially if a Bannwarth syndrome was overlooked or misinterpreted (herniated disc) in advance, chronic neuroborreliosis can occur, which can then – similar to MS – be accompanied by central symptoms (spasticity, bladder disorders, ataxia). But that’s where the similarities end, because neuroborreliosis has a very typical cerebrospinal fluid finding, with which it can be distinguished from MS.
For reassurance: because of this overlap of the two diseases, we always thoroughly examine the cerebrospinal fluid of MS patients for borrelia during diagnosis. Usually, there is no indication of an active infection (but quite often positive antibody titers, which only indicate that the immune system has dealt with the pathogen at some point in the past). Personally, I think there are clear differences between the presentation of MS and neuroborreliosis – the widespread fear of a misdiagnosis is, in my view, relatively unfounded.
