May 1990

Immunologic Reactivity Against Borrelia burgdorferi in Patients With Motor Neuron Disease

Author Affiliations

From the Departments of Neurology (Drs Halperin, Kaplan, Brazinsky, and Delfiner and Mss Cheng and Wu), Pathology (Dr Golightly), Internal Medicine (Drs Dattwyler and Luft), and Physical Therapy (Ms Ironside), State University of New York, Stony Brook; Centers for Disease Control, Fort Collins, Colo (Dr Tsai); Department of Neurology, Nassau County Medical Center, East Meadow, NY (Dr Delfiner); and Department of Neurology, Massachusetts General Hospital, Boston (Dr Brown).

Arch Neurol. 1990;47(5):586-594. doi:10.1001/archneur.1990.00530050110021

• Of 19 unselected patients with the diagnosis of amyotrophic lateral sclerosis (ALS) living in Suffolk County, New York (an area of high Lyme disease prevalence), 9 had serologic evidence of exposure to Borrelia burgdorferi; 4 of 38 matched controls were seropositive. Eight of 9 sero-positive patients were male (8 of 12 male patients vs 2 of 24 controls). Rates of seropositivity were lower among patients with ALS from nonendemic areas. All patients had typical ALS; none had typical Lyme disease. Cerebrospinal fluid was examined in 24 ALS patients—3 (all with severe bulbar involvement) appeared to have intrathecal synthesis of anti-B burgdorferi antibody. Following therapy with antibiotics, 3 patients with predominantly lower motor neuron abnormalities appeared to improve, 3 with severe bulbar dysfunction deteriorated rapidly, and all others appeared unaffected. There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi, at least among men living in hyperendemic areas.