Lyme Disease
(Peripheral Neuroborreliosis)
Airin Lara
What is Lyme Disease?
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It’s a multisystem disorder caused by a bite of Borrelia Burgdorferi (tick)5
Pathophysiology5:
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Etiology5:
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Bite of the tick causes rapid increase of bacteria known as spirochetes in dermis
Body realizes there’s something wrong and send out and alert in for of erytrema chronicum
migrans (rash), can progress in 3 stages
Bite of a Ixodes Dammini tick (deer tick)
Average range of people infected range from 6-89 years old, with median being
38 years2,5
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Anyone who gets bitten can get it
Infection rate has doubled in US from 11,700 in 1995 to 27,200 in 2013
Lyme Disease Functional Effects3
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Vary through 3 Stages
Stage 1:
○ Skin erythema migrans (rash)
Stage 2:
○ Multiple erythema migrans (multiple
rashes)
○ Borrelial lymphocytoma (big puffy
nodule)
○ Lyme neuroborreliosis (2 stages)
○ Carditis (heart inflammation)
Stage 3:
○ Acrodermatitis chronica atrophicans
(skin disease)
○ Lyme arthritis (mostly affects knees)
○ Neurological symptoms (attacks most
of cranial nerves)
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Prognosis6
○ Very good prognosis
○ Antibiotic treatment shortens course and
prevents complications and rare chronic
infections
○ Long term antibiotic treatments are good
○ When treated right recurrences rarely
appear.
Lyme Neuroborreliosis8
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2 Stages
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Early Disseminated Stage:
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Early Disseminated Stage (Stage 2 in Lyme Disease)
Late Disseminated Stage (Stage 3 in Lyme Disease)
Symptoms last weeks to months
98% of cases
Manifestations: meningolopyradiculities, linked to unilateral or bilateral facial paresis
(Bannwarth's Syndrome)
Frequent: radicular pain
Late Disseminated Stage:
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Less than 2% of cases
Neurological symptoms develop slowly over months to years
Manifestations: encephalomyelitis with atactic gait disturbance and bladder dysfunction
Rarely any pain
Boris Borckof
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49 year old male
headache
Stomach ache
Dysarthria
Rash on left leg
Catherine Borckof
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Went backpacking in Virginia few weeks ago, got bitten by a tick
Half of his face is droopy
Sometimes I can't understand him and he‘ll forget what he is saying
He‘s been very moody with a short fuse
Assessment: Perceptual Speech Features4
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Pitch: very low
Loudness: Difficult to arouse
Voice Quality/Resonance: Hypernasal
Articulation: garbled/slurred
Prosody: montonone
Assessment: Objective Findings4
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Adiadochokinesia: tongue, especially elevating and lowering
Oral Mech Exam:
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Structure: Left side of mouth diminished
Function: motor weakness of tongue, unable to protrude and retract tongue
Speech Intelligibility 9
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Measured by: Munich Intelligibility Profile (MVP)
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Word Identification Format: produce list of 72 words from multiple choice format
Scored by several unfamiliar listeners, who would listen and try to identify words
80% intelligibility
Damian has Flaccid Dysarthria due to Lyme
Disease1
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Flaccid: associated with weakness and paralysis of muscles that produce speech
Intervention4
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Therapy focused on maximizing function of all symptoms: Orofacial Exercises
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Used compensatory strategies
Advised to take frequent pauses
Over-articulate
Follow-up Questions
1.
Am I going to have long lasting effects after treatment?
a.
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Most patients recover after a few months, most don’t lasting chronic effects
Chronic Lyme Disease real?Also known as Post Lyme Disease Syndrome
a.
We don’t know know yet, it‘s a big controversy. But as of now evidence does not support chronic
symptoms
References
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American Speech-Language-Hearing Association. (n.d.). Dysarthria in Adults. American Speech-Language-Hearing
Association. https://www.asha.org/practice-portal/clinical-topics/dysarthria-in-adults/
Bransfield, R. C., Aidlen, D. M., Cook, M. J., & Javia, S. (2020). A clinical diagnostic system for late-stage
neuropsychiatric lyme borreliosis based upon an analysis of 100 patients. Healthcare (Basel), 8(1), 13.
https://doi.org/10.3390/healthcare8010013
Cardenas-de la Garza, Jesus Alberto, De la Cruz-Valadez, E., Ocampo-Candiani, J., & Welsh, O. (2019). Clinical spectrum
of lyme disease. European Journal of Clinical Microbiology & Infectious Diseases, 38(2), 201-208.
https://doi.org/10.1007/s10096-018-3417-1
Gustaw, K., & Mirecka, U. (2001). Dysarthria as the isolated clinical symptom of borreliosis--a case report. Annals of
Agricultural and Environmental Medicine, 8(1), 95-97.
Koedel, U., Fingerle, V., & Pfister, H. (2015). Lyme neuroborreliosis-epidemiology, diagnosis and management. Nature
Reviews. Neurology, 11(8), 446-456. https://doi.org/10.1038/nrneurol.2015.121
Nau, R., Christen, H., & Eiffert, H. (2009). Lyme disease--current state of knowledge. Deutsches Ärzteblatt International,
106(5), 72-81; quiz 82. https://doi.org/10.3238/arztebl.2009.0072
Ogrinc, K., & Maraspin, V. (2016). Nervous system involvement in lyme borreliosis. The Open Dermatology Journal, 10(1),
44-54. https://doi.org/10.2174/1874372201610010044
Rauer, S., Kastenbauer, S., Hofmann, H., Fingerle, V., Huppertz, H., Hunfeld, K., Krause, A., Ruf, B., Dersch, R., &
Consensus group. (2020). Guidelines for diagnosis and treatment in neurology - lyme neuroborreliosis. German Medical
Science, 18, Doc03-Doc03. https://doi.org/10.3205/000279
Ziegler, W., & Zierdt, A. (2008). Telediagnostic assessment of intelligibility in dysarthria: A pilot investigation of
MVP-online. Journal of Communication Disorders, 41(6), 553-577. https://doi.org/10.1016/j.jcomdis.2008.05.001