Lyme and a knock to the head

A 31 year old female aquatic animal trainer presented to me 6 months ago. She had been referred by another patient. She complained of headache, dizziness, fatigue, muscle weakness, a loss of balance, tingling and numbness, blurred vision, decreased coordination, episodes of confusion, brain fog, anxiety, irritability, palpitations and episodes of random sweats and chills. The headaches were particularly bad. They were daily, felt like pressure in the front of her head and interfered with sleep.
All the symptoms were new. The symptoms were getting worse. About 2 months before she suffered a closed head injury and a concussion. She had been butted in the head by a dolphin. Initially, I filed this part of the history away and focused on the Lyme evaluation.

Let me insert that she had previously seen numerous physicians including a neurologist. A Brain MRI was negative. No diagnosis or therapy had been suggested.

She tested positive for Lyme disease and seemed to be a fairly typical case. She had a lot of muscle weakness and poor endurance with a loss of strength. The sweating pattern suggested a typical Babesia co-infection syndrome. Treatment with antibiotics produced slow and steady improvement. Antimicrobial therapy included Amoxicillin, Biaxin, Flagyl and Mepron. After several months the improvement was incremental but slow. She was unable to work and was concerned that she might be disabled for an extended period of time. I felt that she was doing fairly well. It would take time; she would eventually be able to return to work. It is impossible to predict how long it will take for a particular patient to get better. Nonetheless, every time I see a patient for follow up I review the initial, presenting symptoms: which symptoms have improved and which have not. About 6 weeks ago I noted that the headaches were quite disabling and had not improved to any significant extent. The headaches had a migraine like quality. Empirically, I prescribed a migraine preventing medicine, Topomax.

When I was her last week I was surprised by her dramatic improvement. The Topamax made a huge difference. The headaches resolved, her sleep improved and virtually all the other symptoms disappeared as well. It was a rather amazing transformation. She had scheduled her return to work- full time.

In retrospect her case looks a bit different. I still believe she suffers with chronic Lyme disease, but this may not have been her main problem. Her illness was triggered by a closed head injury and a concussion. Patients can suffer with a post-concussion syndrome which can persist for many months.

Headaches which resemble migraines and all the other presenting neurological symptoms can be seen in post-concussion syndromes. I have seen many such patients over the years. They frequently experience dizziness, balance issues, visual changes, mood swings, memory loss, brain fog and even bouts of frank confusion or disorientation. All of these symptoms dovetail nicely with many of those associated with typical neuro-Lyme- and this patient's initial list of symptoms.

The connection between fibromyalgia and sleep problems has been well known for decades. Patients deprived of deep sleep, stage 4 delta sleep, all develop a fibromyalgia like syndrome after a period of several weeks, as has been experimentally shown.

The improvement in muscle symptoms could be related to the improvement in sleep that she was experiencing. Perhaps the restoration of brain function caused the marked improvement in muscle symptoms by some other mechanism.

Asymptomatic, persistent Lyme infection be transformed into an active process by another illness, usually an infectious illness. I have seen this many times. In this case I suspect that the neurological injury triggered by the concussion and the associated sleep deprivation, created an environment permitting activation of Lyme- and perhaps Babesia.