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 Children & Lyme Disease

REMOVE THE TICK PROPERLY!

PHOTOGRAPH ANY RASH! 

Get copies of all test results. It is your right to get copies, don't take no for an answer! Keep a folder with all medical records. Put all requests to the school or doctor in writing, date them and keep a copy.

Please Read This Disclaimer: I am not a medical doctor. The purpose of this site is not to diagnose or cure any disease or malady, but is presented as food for thought. What you read on this site is based on my own history and ideas. This information cannot take the place of professional medical advice. Any attempt to diagnose and treat an illness should come under the direction of a physician. No guarantees are made regarding any of the information presented in this website.

Is It LYME????? Symptom list and more

Tick-Borne Diseases- Lyme is not the only pathogen spread by the bite of a tick.
http://www.lymesite.com/co-infections.htm

Financial HELP, great site with lots of links to groups and agencies which may be able to help kids with TBD
http://www.pocwl.org/fundhelp.html

The ABC's of Lyme Disease http://www.lymediseaseassociation.org

The Invisible Disabilities Site
http://www.invisibledisabilities.com/rings.htm

Things you should know about IDEA
Anyone who has been in contact with the special education system in the last several years has probably heard of the Individuals with Disabilities Education Act or IDEA for short. This is a great piece of legislation in that it finally legitimized the role of parents in the special education process. Unfortunately, according to a recent federal survey, not every school district is following the intent or even the letter of the law. To be an effective advocate it is to your advantage to be familiar with this law so that you know when it is & when it's not being followed.
 http://www.ideapractices.org/

Dr. Charles Ray Jones, a TRUE saint http://www.wildernetwork.org/LDpediatricfund.html

Understanding the IEP (Individual Education Plan)

http://www.ldonline.org/ld_indepth/iep/iep.html

The Importance of Good Communication Skills (Acrobat Reader required)A publication of the Fairfax County Virginia Public School written by Marcia Goldberg,Educational Specialist for The Parent Resource Center, gives basic points on resolving differences. 
http://www.ldonline.org/ld_indepth/iep/iep_communication.pdf

 Keeping track of your communications is easier if you make notes immediately following the conversation or visit. Take a few minutes each time to record your calls and visits. Do this for every phone call or meeting. 
http://www.ldonline.org/ld_indepth/iep/phone_visit_log.html
Work the following puzzle with your LD teenager.

Summer is coming.   Finding good summer activities for children with learning disabilities and/or ADHD takes careful planning.  
http://www.ldonline.org/ld_indepth/summer/

FDA Medical Bulletin * Summer 1999 * Final Issue/ Lyme Disease Test Kits: Potential for Misdiagnosis
http://www.fda.gov/medbull/summer99/lyme.html

Cognitive Deficits identified in Children with Chronic Lyme Disease (12/1999).
http://www.columbia-lyme.org/dept/nyspi/flatp/breaknewsfull.html#persist
 

Manifest determination hearings follow disciplinary actions by the school that result in expulsion or a changing in placement. If a disciplinary action involves a request for a suspension or other actions involving removal from a program for more that ten days, the IEP team must meet to determine whether the misconduct resulted from the disability. This is referred to as a manifest determination hearing, review or IEP meeting.

http://www.ldonline.org/ld_indepth/legal_legislative/manifest_determination.pdf

Strategies for the Reluctant Writer
http://www.ldonline.org/ld_indepth/writing/reluctant_writer.html

Lyme Disease: The Unknown Epidemic
by D. J. Fletcher and Tom Klaber
Millions of people who are diagnosed with multiple sclerosis, fibromyalgia, Alzheimer's, chronic fatigue syndrome and other degenerative diseases could have Lyme Disease causing or contributing to their condition.
Forget just about everything you think you know about Lyme disease.
http://www.mercola.com/2001/jul/25/lyme_disease.htm

Lyme Disease: The Great Imitator
http://www.chiroweb.com/archives/10/20/05.html

Lyme Disease: The Great Imitator, Part II
http://www.chiroweb.com/archives/10/23/03.html

Long-term cognitive effects of Lyme disease in children. "Therefore, in contrast with studies of adults with LD, the results of long-term follow-up of the pediatric population continue to strongly support the finding that children treated appropriately for LD have an excellent prognosis for normal cognitive functioning."
Click Here for Abstract

Developmental Delay and Lyme Disease
in Children: An epidemiologic study
Participants: Children with Lyme Disease & Autism from New Jersey and Connecticut

http://www.columbia-lyme.org/flatp/childstud-n.html

Lyme & Other Tick-borne Diseases: Focus on Children & Adolescents/ Order a video of this conference at LDANJ 
http://www.lymenet.org/files/LDAconfflyer.pdf

NEUROLOGICAL MANIFESTATIONS OF
LYME DISEASE IN CHILDREN by,
Dorothy M. Pietrucha, M.D., P.A.
http://www2.lymenet.org/domino/file.nsf/UID/pietrucha

The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Fallon BA, Kochevar JM, Gaito A, Nields JA.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9774805&dopt=Abstract

Neuroscience for Kids - Lyme Disease (mostly good info, some poor)
http://faculty.washington.edu/chudler/lyme.html

Children with Lyme disease, and their parents, face unique challenges and situations. Parents of Lyme Kids allows a place for parents to come together and discuss these challenges and situations, to find support among others and to seek advice from those who "have been there".
http://groups.yahoo.com/group/Parents_of_Lyme_Kids/

HYPERBARIC OXYGEN THERAPY IS PROVING TO BE ABLE TO TAKE CHILDREN SIGNIFICANTLY BEYOND THE LIMITS OF THE IMPROVEMENTS THAT WERE PREVIOUSLY THOUGHT POSSIBLE
http://hbotofaz.org/resources/research/newhope.html

Effects of Hyperbaric Oxygen Therapy On Lyme Disease
http://www.hbotoday.com/treatment/clinical/researchstudies/effectsonlyme.shtml

When should a doctor suspect that a neuropsychiatric problem is the result of Lyme disease?
"If the only thing a patient has is depression or anxiety, Lyme disease would be low on the list of possibilities," Dr. Fallon said. "But if he or she has mood swings, attention problems, or memory problems, as well as some joint pains and some numbness and tingling, you have to consider Lyme disease, especially in the greater New York area, where it is endemic.
“And anytime you see a young patient with memory problems, then you have to start wondering, could this be Lyme disease?"
http://www.pslgroup.com/dg/3fc1a.htm
 

A Controlled Study of Cognitive Deficits in Children With Chronic Lyme Disease
Felice A. Tager, Ph.D., Brian A. Fallon, M.D., John Keilp, Ph.D., Marian Rissenberg, Ph.D., Charles Ray Jones, M.D. and Michael R. Liebowitz, M.D.
Received August 7, 2000; revised January 3, 2001; accepted January 10, 2001. From the Columbia University Department of Psychiatry, Division of Behavioral Medicine, New York, New York. Address correspondence to Dr. Tager, Columbia Presbyterian Medical Center, 622 West 168th Street, Box 427, New York, NY 10032. E-mail:
ft49@columbia.edu.

Although neurologic Lyme disease is known to cause cognitive dysfunction in adults, little is known about its long-term sequelae in children. Twenty children with a history of new-onset cognitive complaints after Lyme disease were compared with 20 matched healthy control subjects. Each child was assessed with measures of cognition and psychopathology. Children with Lyme disease had significantly more cognitive and psychiatric disturbances. Cognitive deficits were still found after controlling for anxiety, depression, and fatigue. Lyme disease in children may be accompanied by long-term neuropsychiatric disturbances, resulting in psychosocial and academic impairments. Areas for further study are discussed. 
J Neuropsychiatry Clin Neurosci 13:500-507, November 2001
© 2001 American Psychiatric Press, Inc.

http://neuro.psychiatryonline.org/cgi/content/abstract/13/4/500

The Spectrum of Gastrointestinal Manifestations in Children and Adolescents
with Lyme Disease

http://www.jpgn.org/pt/re/jpgn/fulltext.00005176-199910000-00050.htm;jsessionid=DR3BT1kG6wI92fuPP2ZEi5WZfuF6wQpq2ETBKWUAUbPkn17fDoW5!-1202648512!-949856145!9001!-1

Psychologic disorders in acute and persistent neuroborreliosis
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11320549&dopt=Abstract

Neurologic manifestations of Lyme borreliosis in children
http://x-l.net/Lyme/neuroch.htm

Neuropsychological Evaluation of Children with Lyme Disease: Implications
for Education and Treatment

http://www.canlyme.com/fallonreview.html

Lyme disease is clearly a very complex disease. When considering a similar spirochete disease, syphilis, it has been said, "To know syphilis is to know medicine." However, to know Lyme disease is not only to know medicine but also neurology, psychiatry, politics, economics, and law. The complexity of this disease and all that surrounds it challenges our scientific as well as our ethical capabilities. I shall not address every aspect of this disease but I shall focus on diagnosis, in particular from a psychiatric perspective. http://www.mentalhealthandillness.com/lymeframes.html

Not Just a Sore Throat
Common childhood infection may trigger neurological disorder
/ More information can be accessed at the official PANDAS Web page at the
National Institute of Mental Health at

http://intramural.nimh.nih.gov/pdn/web.htm

SPECT can be helpful in understanding and treating aggressive behavior. I have found a consistent triad of SPECT findings common in children, teenagers and adults who exhibit aggressive behavior.
SPECT is often used as a diagnostic tool for Lyme. Hypoperfusion (low blood flow) to the prefrontal lobes is a common finding in Lyme infected patients.
http://www.brainplace.com/

White Matter Lesions- MRI is often used as a diagnostic tool for diagnosing Lyme. Often patients with Lyme have "White matter lesions" in the brain or spine.  http://path.upmc.edu/cases/case59.html

Art Doherty's Children and Lyme
http://www.geocities.com/HotSprings/Oasis/6455/children-links.html

Chronic neuroborreliosis in infancy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10933439&dopt=Abstract

Children Find Relief From Migraine Through Biofeedback And Relaxation Training
http://www.intelihealth.com/IH/ihtIH/EMIHC000/333/333/308130.html

Working With Families of Suddenly and Critically Ill Children 
http://archpedi.ama-assn.org/cgi/content/abstract/154/11/1127

Advocacy in Action
You Can Advocate for Your Child!

http://www.ldonline.org/ld_indepth/parenting/cec_advocacy.html

SPECIAL HELP FOR STUDENTS WITH CHRONIC LYME DISEASE

Chronic Lyme Disease clearly impacts academic performance. Neurological and psychiatric symptoms may persist long after physical complaints are manageable. A child may appear physically well and be quite active yet have cognitive or behavioral problems related to continued infection. Some students are so sick that they are home bound. The central cognitive deficits relate to problems with keeping focused and retrieving information from memory, which may manifest as forgetting, trouble paying attention in class, easy distractibility, restlessness and irritability. In some hyperendemic counties, there are entire classrooms of students with chronic Lyme Disease. In New Jersey, it is a state law for teachers to receive training on the subject. Students with chronic Lyme disease are covered under Federal law by section 504 of the Rehabilitation Act of 1973, as well as the Individuals with Disabilities Act (IDEA) of 1996 as "Other Health Impaired". Students are entitled to receive special modifications of their academic programs so that they may be as successful as possible given their individual limitations. For more information and books, articles and videos that address Lyme disease and the schools call 203 222-7089. 
 

EDUCATION/children are being improperly classified

Between Jan 1, 1996 and December 31, 1997, NJ had almost 4000 newly reported cases of LD. These cases are only the ones that fit the Centers for Disease Control, CDC, criteria for surveillance. Many more people were actually diagnosed by physicians with estimates from some medical professionals indicating that the 4,000 reported cases represent only 1/10 the actual cases in NJ. NJ has traditionally ranked either third or fourth in the nation for reported LD cases, many of which are children.
When children develop chronic Lyme, they are not only fighting disease, but also they and their parents must fight to get a proper education. Numerous school districts are unaware of the problems of LD and its potential psychiatric manifestations. Therefore, instead of getting proper treatment for the disease causing the symptoms, the children are being ignored, punished, or ostracized. Sometimes children are getting improperly classified or not classified at all because some individuals think Lyme is not a serious disease.
In 1992, I prepared and presented to Congressman Smith, the CDC, and the NIH, National Institutes of Health, a 9 district school study showing the impact of Lyme disease on children. As a result of my study, the CDC came to NJ and studied Lyme in 5 of those 9 Monmouth and Ocean districts. This Oct. 1992 CDC study of 64 students showed that the median duration of illness at the time of interview was 363 days, and the mean number of school days missed because the child was too ill to attend was 103 days (with a range of 2 to 548 days). The median duration of home instruction was 98 days, with a range of 5 to 792 days.
Another study by NJ family therapist Maggie Smith shows an 11.2 months average school absence due to Lyme disease. The cost estimate available for medical treatment for 54 of the CDC study children was $5.2 million, and more than one-third of families of the affected children had 3 or more members who had at some time been diagnosed with Lyme, and 40% of the mothers were LD diagnosed.
78% of the parents stated that their children experienced a fall in grade point average during the time of illness, 79% experienced a decrease in the number of friends. A quote from the CDC study sums up the magnitude of the problem: "Perhaps the greatest costs incurred by the study children were the social costs of the illness and its treatment. Schooling and extra-curricular learning activities were seriously interrupted for most children; often, children spent large blocks of time as semi-invalids, isolated from social groups and missing out on cultural, sports, and social activities. School performance of nearly all children fell, sometimes drastically, and in several instances was said to interfere with selection by colleges and universities." In NJ, school districts are required by 18A to train annually any staff members who work with children who have LD. There is a statewide curriculum that was prepared by the NJDOE and distributed in 1995 to all NJ districts entitled "Making a Difference: Lyme Disease Prevention Education Guide." 18A encourages, but does not mandate, that districts in a high Lyme disease incidence area adopt the curriculum guidelines. For the most part, districts are unaware of the mandatory legal requirement for teacher training and unaware of this curriculum. For several years, I have been working with districts statewide training teachers and acting as an advocate in IEP meetings for children with Lyme. This is the fifth statewide school conference the LDANJ has hosted in NJ. Schools usually either classify children with Lyme as chronically ill or they develop 504 plans under federal legislation. Classification costs the district a lot more money, however, they do receive some state aid for that. 504 students do not usually generate additional aid for the district but the identification process is simpler. Districts need to understand that parents/students have similar rights under 504 as they do under the classification with an IEP, Individualized Education Program. Often, children exhibit behavior problems that are associated with Lyme disease and these go unrecognized by districts. At times, children are being improperly classified. For example, they have psychiatric or neurologic manifestations and they are labeled NI (neurologically impaired) or ED (emotionally disturbed) when perhaps a multiply handicapped classification which includes chronically ill might be necessary. The new special education guidelines being developed could be a problem for children with Lyme whose designation is often neurologically impaired, since the definition of neurological impairment will be more strictly defined to agree with federal guidelines. Children are identified with ADD, attention deficit disorder, medicated for those symptoms, and no cause is ever sought. Districts need to carefully evaluate any child who has a history of Lyme and is experiencing neurologic, psychiatric, and attention deficit problems to ensure that the problems are not organically produced by Lyme disease. Fluctuations in symptoms present another problem. Lyme symptoms can vary from day to day and even hour to hour. Children with LD on long term home instruction may need to have a school program which enables them to come to school when feeling well and receive home instruction when they are not. They should not have to wait 10 days or any set number of days to receive the home instruction after each absence. Flexibility must be written into the IEP or 504 plan. The number of hours of home instruction needs to be adequate to provide a thorough and efficient education. Often, districts only provide 5 hours a week to a child, telling parents this is all they need to provide by law. Classified children may receive 10 hours of home instruction per week. 5 hours is certainly not adequate to provide a thorough and efficient education for children on long term home instruction. Specify the hours in the IEP or 504 plan. Teachers must utilize alternative instruction strategies such as testing orally, breaking up periods of instruction, taping books and lectures, and allowing extra time for assignments. Additionally, they must pay careful attention to students' physical needs such as light and sound sensitivity and the need to get up and move around. Recurrent short-term memory problems, mental confusion, and exhibition of dyslexic type symptoms are not uncommon and interfere with the learning process. A number of peer-reviewed articles by Dr. Dorothy Pietrucca, pediatric neurologist, and Dr. Brian Fallon, psychiatrist, address these issues in school-aged children and can be used to reinforce the learning problems associated with Lyme. Parents need to work with the school and should not be intimidated by district officials. I have seen children who have missed years of school and been able to graduate with their peers, and I have seen others who have fallen behind and not finished. The difference is usually the parent's involvement. And schools often will cooperate after they are inserviced and understand the severity of the problem.
Childhood is a time in which children should be giving reign to their natural curiosity and exploring the world, learning how to develop relationships with their peers, and enjoying life before they are burdened with adult responsibilities. Because of intense physical and emotional pain, Lyme children do not live life, they exist. Someone near and dear to me with Lyme wrote the following poem 4 years ago at age 16. It is entitled "The Eternal Nightmare." 

Pat Smith, President  LDANJ March 1998

 

BULL'S-EYE
- Targeting Lyme Disease -
Excerpts from Vol. 10.1, February 2000
Nervous System Manifestations of Lyme Disease in Children
By Michael K. Sowell, MD (Pediatric Neurologist)
(Reprinted with permission - Spotlight on Lyme, Vol. 4, No.6)
Lyme disease is the most common vector-borne (transmitted by non-humans)
disease in the United States and Europe. It is a multi-system disease which
may affect the skin, eyes, heart, musculoskeletal system and nervous system.
Lyme disease in children merits special consideration because of its
potentially devastating effects on the developing brain. Furthermore, some
of the neurologic symptoms of Lyme disease may be more difficult to
elucidate in children because of their inability to convey their symptoms,
due to their developmental limitations.
It is said that Lyme disease is the "New Great Imitator", which emphasizes
that Lyme disease can affect virtually any area of the nervous system as
well as imitate other diseases. This is particularly true in view of the
difficulties of establishing a firm diagnosis (reviewed elsewhere). This
brief article is intended to be an overview of the potential neurologic
manifestations of Lyme disease in children.

Ocular manifestations in children and adolescents with Lyme arthritis

Br J Ophthalmol 1999;83:1149-1152 ( October )
Ocular manifestations in children and adolescents with Lyme arthritis
Hans-Iko Huppertza, Doris Münchmeiera, Wolfgang Liebb
a Children's Hospital, University of Würzburg, Würzburg, Germany, b
Department of Ophthalmology, University of Würzburg, Würzburg, Germany
Correspondence to: Professor Dr med Hans-Iko Huppertz, Zentralkrankenhaus
Sankt-Jürgen-Strasse, Professor-Hess-Kinderklinik, 28205 Bremen, Germany.
Accepted for publication 25 July 1999
BACKGROUNDLyme arthritis is the most frequent late manifestation of Lyme
borreliosis and has been associated with ocular inflammation.
METHODSA group of 153 children and adolescents with arthritis, 84 of whom
had Lyme arthritis and 69 other causes of arthritis, were followed
prospectively for 22-73 (median 44) months in the course of a national
study.
RESULTSThree of 84 patients with Lyme arthritis had ocular inflammation
(4%), including keratitis, anterior uveitis, and uveitis intermedia. All
three had symptoms of decreased visual acuity. Whereas anterior uveitis
disappeared without sequelae, a corneal scar and a permanent loss of visual
acuity in the patients with keratitis and intermediate uveitis remained.
Systematic examination of all patients revealed no further ocular
involvement. Of 69 patients with other causes of arthritis who were followed
in parallel as a control group, four of 15 patients with early onset
pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis
and two of 12 patients with juvenile spondyloarthropathy had acute anterior
uveitis.
CONCLUSIONSOcular involvement with keratitis, anterior uveitis, and
intermediate uveitis may occur in children and adolescents with Lyme
arthritis. Visual loss appears to be symptomatic, making regular ocular
screening of such patients unnecessary.
© 1999 by British Journal of Ophthalmology

www.dailyitem.com
Lyme disease turned 180-pound son into 130-pound little boy
By Joanne Troutman
Staff reporter


The nightmare began in September 1997 for then 13-year-old Matt Peters of Northumber-land. It was, at first, the dizzy spells the presumably healthy football player started experiencing. We thought he was having an allergy problem, recalls his mother, Helen Peters.
When the dizziness subsided, Helen and her husband, Monte, didn't think there was anything to be concerned about.
Then, just before Christmas, the cough started.
Matt's parents took him to their family physician, who placed Matt on a series of different antibiotics for a few weeks to treat what he diagnosed as bronchitis.
When the cough persisted, the family and doctor became worried and decided it was time to take a more aggressive approach.
The next stop was an examination in February 1998 at Hershey Medical Center, where Matt was hospitalized for a few days.
It was not long before doctors there told Matt the cough was all in his head, Helen says. They took him off the antibiotics and prescribed Zoloft, an antidepressant medication.
That's when things really took a turn for the worse. Matt walked into Hershey and we had to wheel him out, Helen says, matter-of-factly.
Within a few days, walking became so laborious that it took Matt 15 minutes to get from his hospital room to the end of the hallway, a distance of only 20 to 30 feet. And it didn't get any better. His knees began to swell tremendously, and he wouldn't open his eyes or eat. He soon began needing a walker when he wasn't in a wheelchair.
The Peters decided to take Matt to a local hospital, Geisinger Medical Center in Danville, hoping physicians there would do something for their son.
The doctors performed several tests on Matt. The teen was bounced from department to department, with doctors trying to determine exactly what was wrong. The only test that came back abnormal was a spinal tap, Helen says, with an increased protein level suggesting a possible infection. One doctor did recognize that the reason Matt wasn't opening his eyes was because they were sensitive to light.
But none of the blood tests showed anything out of the ordinary. After another series of tests, including an MRI, Geisinger doctors concurred with the diagnosis at Hershey Matt was severely depressed.
They said the cough was coming from a chemical imbalance in his brain, Helen says.
It wasn't that they weren't trying, she says about her despair in the diagnosis. But they kept saying this was in his head. I could tell he was in pain.
They just didn't recognize that he was feeling real pain and he needed help.
The doctors increased the antidepressant medication and sent him home.
In March, Matt stopped going to school. He was having panic attacks and was routinely dehydrated from refusing to eat or drink. His father had to carry him up steps because he couldn't walk.
He spent a lot of time in bed sleeping, Helen said.
In the meantime, Matt's behavior had become out of control. His parents started taking him to a counselor in Lewisburg.
It was when we saw the counselor that she thought there was something more to this, Helen said.
The counselor was the first to suggest Lyme disease.
Lyme disease is a tick-borne infection caused by Borrelia burgdorferi bacteria, a spirochete similar to the bacteria that causes syphilis. The Borrelia bacteria is typically carried by ticks that embed themselves in deer.
The disease is passed on to humans when deer ticks embed themselves in human skin to feed, subsequently causing a variety of symptoms.
It was first discovered in the United States in the 1970s when Dr. Willy Burgdorfer began researching a cluster of patients diagnosed with juvenile rheumatoid arthritis in Lyme, Conn.
However, the disease is thought to have been around for more than a century worldwide.
The counselor in Lewisburg told the Peters family that Lyme bacteria could manifest itself in the brain, causing many of the neurological symptoms Matt was experiencing.
The Peterses weren't sure what to think of the suggestion.
I didn't see a tick on him, and he didn't have a bulls-eye rash on him that we knew of, Helen said.
Plus, Matt had previously had all the usual blood tests recommended by the Centers for Disease Control for reporting Lyme disease, and none indicated Lyme under the guidelines.
But the counselor suggested a different test and a different doctor.
They needed to do something.
They thought their son was dying.
We saw him rolling up into a ball, Helen said. Everything was shutting down in his body ... I had this very active football player lying in bed in pain. There was something wrong.
His bowels and kidneys no longer functioned properly. He constantly had a severe headache and rarely opened his eyes because light hurt them too badly.
A healthy 180-pound middle school football player had become a feeble 130-pound little boy in a matter of months.
The family sent a urine specimen to Pittsburgh for analysis through a urine antigen test. The results came back borderline for Lyme disease.
The Peterses then scheduled an April visit to a pediatric doctor in New York who specializes in Lyme.
It was at her office that the Peterses learned that the rash Matt developed after cutting weeds in the family's rural Northumberland backyard a few years before was symptomatic of the disease. It was a rash that looked like poison ivy with a black mark in the center.
We didn't know there could be other rashes, Helen said.
Although the ELISA and Western Blot blood tests, as well as more direct tests such as the urine antigen screening, all came back borderline, the New York doctor clinically diagnosed Matt with advanced Lyme disease.
She placed him on antibiotics immediately. By the end of May, with the help of a local family doctor and Hershey Medical Center, Matt was receiving antibiotics intravenously.
Then we started a life with IV antibiotics that lasted a very long time, Helen says.
Matt's behavior continued to be a problem. He says he can't remember much of what happened while he was very sick. His mother won't elaborate on specifics, but she said he would do anything with food but eat it.
He wouldn't get angry, he would get furious, Helen says.
Throughout the summer, Matt had to wear sunglasses for light sensitivity. And the teen was still using a walker and wheelchair regularly. By this time, the muscle tone in his thighs decreased from inactivity, causing his knee caps to drop. He had to go to physical therapy to regain his strength.
He managed to get through seventh grade by doing his work at home. When eighth grade began, he went to school half-days and gradually increased to full days. He couldn't play football, but his teammates convinced the coach to allow him to wear a jersey and stay on the sidelines.
He was getting better. By March 1999, Matt was well enough to stop the IV antibiotics. He continued taking pills for a few months.
His last test for Lyme in June showed that there was less bacteria than was previously detected. And now, he's feeling better than ever. He has been in school full-time and he even played football last fall.
But there are still the emotional issues to deal with.
Helen says Matt kept a journal throughout his illness and refuses to look at it.
And he got really upset if any of us looked at the journal, she says. There were a lot of things in there I'm sure I wouldn't want to know.
Matt doesn't say much about his illness. But the expression on his face when you ask him about the pain says it all.
There was a lot of stuff I wanted to do, but I couldn't, he says, his eyes welling up with tears.
Matt doesn't want pity. What he does want is to be a normal 15-year-old boy who gets recognition for a disease that could have ruined his life and did so briefly.
(People) just don't understand, Matt says. They think it's no big deal ... but it is.
Neuroimaging in Neuropsychiatric Lyme Disease: Uses, Abuses, and the Future

Neuroimaging in Neuropsychiatric Lyme Disease: Uses, Abuses, and the Future
Brian A. Fallon, MD, Columbia University College of Physicians & Surgeons
Structural Brain Imaging

MRI scans among patients with neurologic Lyme disease may demonstrate
punctate white matter lesions on T2 weighted images, similar to those seen in demyelinating or inflammatory disorders, such as multiple sclerosis, systemic lupus erythematosus or cerebrovascular disease. In early neurologic Lyme disease, hyperintensities may be seen in as many as 50% of patients with evidence of meningitis or encephalitis. Comparable to meningo and cerebrovascular syphilis, European authors suggest that CNS micro- and macrovasculitis may cause both clinical symptoms and MRI changes in patients with CNS Borreliosis.
The usefulness of MRI scans in American chronic Lyme encephalopathy is less clear, with abnormalities seen 15% to 41% of the time. After treatment, roughly half of the patients may show resolution of the signal hyperintensity. In late stage encephalomyelitis, MRI scanning often
demonstrates focal areas of inflammation, most commonly in the white matter and occasionally in the cortical and subcortical gray matter of the brain.
Combined MRI and PET studies can help to examine the pathophysiology of these hyperintense areas (perfusion, reactivity to hypercapnia, metabolism)
and whether they have prognostic significance. Do these hyperintensities represent demyelination or perivascular inflammation? Is the disease
process underlying the hyperintensities primarily neuronal metabolic or vascular? FLAIR sequence and magnetization transfer techniques can be used to maximize the yield on identifying white matter hyperintensities.
Functional Brain Imaging
Single photon emission computerized tomography (SPECT) and positron emission tomography (PET), provide a dynamic picture of the brain's
functioning: metabolism, blood flow, and chemistry. In comparison to SPECT scans, PET scanning is able to provide better spatial resolution images
(4-6 mm vs. 6-9 mm) and can be used to provide an absolute quantitative assessment of regional perfusion or metabolic abnormalities. SPECT studies of patients with Lyme disease reveal multifocal areas of decreased perfusion in both the cortex and the subcortical white matter. Logigian
reported that patients with definite Lyme encephalopathy had significantly more perfusion deficits that patients with possible LE who in turn had significantly more deficits than normal controls. After treatment with one
month of IV ceftriaxone, a partial reversal in brain perfusion deficits was observed, raising the question of whether longer antibiotic therapy may
have resulted in even fewer perfusion deficits.
Hypoperfusion defects visualized on SPECT scans may result from any process that alters the radiotracer distribution, including vascular delivery to neurons, transport of the tracer into the cells, and retention of the radioactive tracer in the cells. Problems may arise secondary to direct
infection of neurons, from cellular dysfunction due to the indirect effects of neurotoxic immunomodulators such as cytokines, or from decreased perfusion through arterioles secondary to vasculitis. In other words, areas of hypoperfusion may result from a cellular-metabolic and/or a vascular problem.
How may clinical SPECT scans be useful? First, a scan with diffuse abnormalities may confirm that an objective abnormality is present in a
patient considered to have a factitious disorder. Second, a normal scan in a patient with prominent neuropsychiatric symptoms may suggest that a
psychiatric disorder is the primary cause of a patient's distress and not Lyme disease. Third, improvement after treatment provides objective
evidence of physiologic change.
How may clinical SPECTs be abused? One cannot conclude from a SPECT scan that a patient has Lyme disease, as similar patterns of abnormality may be seen with other diseases as well. Other disease processes that demonstrate a heterogeneous tracer uptake include vascular dementia, chronic fatigue syndrome, CNS Lupus, HIV encephalopathy and chronic or acute stimulant abuse.
Future Studies
Studies combining MRI and PET technology, MR Spectroscopy and functional MRI will each contribute significantly to our understanding of the
patholophysiology of chronic neurologic Lyme disease.  

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