All Posts Tagged With: "neurologic symptoms"

Excerpt:

If you have multiple sclerosis (MS)––or you know someone who does––you probably remember how long it took to make the diagnosis.  You also may remember a lot of blood tests, a lumbar puncture, at least one magnetic resonance imaging (MRI) scan, as well as many visits and examinations by various doctors.  You may wonder why it still takes so long to make the diagnosis in this modern age of MRIs and other sophisticated tests.  We are going to try to explain why it can be so difficult for even the most expert MS neurologist to determine that someone has MS.  You have to live with the diagnosis and face the disease and the treatments.  You should understand and have confidence in the diagnosis.  Also, if your case of MS does not fit the typical pattern, you need to be aware of the other disorders that can mimic MS.  This is important because the treatments may be very different and, just as in most cases of MS, treatment begun early in the course of the disease is the best way to prevent or slow further neurologic damage.

MRI and new laboratory tests have definitely helped speed the diagnosis, but it still takes longer than anyone would wish, even in easy cases.  This is partly because of the variable nature of the disease in its many signs and symptoms. But it is also because a rather long list of other medical disorders can cause neurologic symptoms and signs that resemble MS. Furthermore, the “white spots” on brain MRI can be caused by a number of other conditions that also need to be ruled out.

The diagnosis of clinically definite MS requires that a person experience at least two neurologic symptoms of the type seen in MS, in two different areas of the central nervous system (CNS), at two different times (‘disseminated in space and time’).  Most typically, the symptoms are optic neuritis plus either an abnormal sensation or a problem with movement.  It can also be numbness in one part of the body and weakness or lack of coordination in another.  But in every case, there can be no other explanation for the symptoms, the changes seen on the MRI, and the abnormalities in the spinal fluid.  Many “mimics” need to be ruled out in order to make the diagnosis of MS. 

Excerpt:

Although intravenous antibiotic therapy is recommended for
neurologic Lyme disease, safety concerns have been raised about
treatment beyond 30 days in patients with persistent neurologic
symptoms. The goal of our study was to evaluate the safety of
extended intravenous antibiotic therapy in patients referred for
treatment of neurologic Lyme disease.

METHODS: We enrolled 200
consecutive patients with significant neurologic symptoms and
positive testing for Borrelia burgdorferi. Patients were treated
with intravenous antibiotics using various intravascular devices
(IVDs). Standard IVD care was administered to all patients, and
monitoring for medication reactions and IVD complications was
performed on a weekly basis.

RESULTS: The mean length of intravenous
antibiotic treatment was 118 days (range, 7-750 days)
representing 23,654 IVD-days. Seven patients (3.5%) experienced
allergic reactions to the antibiotic medication, and two patients
(1.0%) had gallbladder toxicity. IVD complications occurred in 15
patients (7.5%) representing an incidence of 0.63 per 1,000
IVD-days. The IVD problems occurred an average of 81 days after
initiation of treatment (range, 7-240 days). There were six
suspected line infections for an incidence of 0.25 per 1,000
IVD-days. Only one of the IVD infections was confirmed, and no
resistant organisms were cultured from any patient. None of the
IVD complications were fatal.

CONCLUSION: Prolonged intravenous antibiotic therapy is
associated with low morbidity and no IVD-related mortality in
patients referred for treatment of neurologic Lyme disease. With
proper IVD care, the risk of extended antibiotic therapy in these
patients appears to be low.