1. Explains how Lyme Disease can mimic attention deficit hyperactivity disorder(ADHD), depression, and multiple sclerosis

ADH <http://x-l.net/Lyme/underdiagnosis of neuropsychiatr.htm>

Psychiatr Clin North Am 1998 Sep;21(3):693-703, viii

The underdiagnosis of neuropsychiatnc Lyme disease in children and adults.

Fallen BA, Kochevar JM, Gaito A, Nields JA

Department of Psychiatry, Columbia University Medical Center, New York,

New York, USA.

Lyme Disease has been called "The New Great Imitator," a replacement for that old "great imitator" neurosyphilis. This article reviews the numerous psychiatric and neurologic presentations found in adults and children. It then reviews the features of Lyme Disease, which makes it almost uniquely hard to diagnose, including the complexity and unreliability of serologic tests. Clinical examples follow that illustrate those presentations of this disease that mimic attention deficit hyperactivity disorder (ADHD), depression, and multiple sclerosis.

2. Talks about cognitive disorders related to Lyme Disease:

<http://www2.lymenet.orq/domino/abstract.nsf/UID/98194892>

The Lyme Disease Network

Medical / Scientific Abstract

Title: Neurocognitive abnormalities in children after classic manifestations of Lyme disease.

Authors: Bloom BJ, Wyckoff PM, Meissner HC, Steere AC

Source: Pediatr Infect Dis J 1998 Mar; 17(3): 189-96

Organization: Division of Rheumatology/Immunology, Tufts University School of Medicine, and the Floating Hospital for Children, Boston, MA, USA.

Abstract:

BACKGROUND: In adults a subtle encephalopathy characterized primarily by memory impairment, irritability and somnolence may occur months to years after classic manifestations of Lyme disease. However, only limited information is available about whether there is an equivalent disorder in children. METHODS: Case series of five children seen in a Lyme disease clinic in a university referral center for evaluation of neurocognitive symptoms that developed near the onset of infection or months after classic manifestations of Lyme disease. The diagnosis was based on clinical symptoms, serologic reactivity to Borrelia burgdorferi and mtrathecal antibody production to the spirochete. Evaluation included detailed neuropsychologic testing. After evaluation the children were treated with intravenous ceftnaxone for 2 or 4 weeks. Follow-up was done in the clinic and a final assessment was made by telephone 2 to 7 years after treatment. RESULTS: Along with or months after erythema migrans, cranial neuropathy or Lyme arthritis, the five children developed behavioral changes, forgetfulness, declining school performance, headache or fatigue and in two cases a partial complex seizure disorder. All five patients had IgG antibody responses to B. burgdorferi in serum as well as intrathecal IgG antibody production to the spirochete. Two patients had CSF pleocytoses and three did not. Despite normal intellectual functioning the five children had mild to moderate deficits in auditory or visual sequential processing. After ceftriaxone therapy, the four children in whom follow-up information was available experienced gradual improvement in symptoms. CONCLUSIONS: Children may develop neurocognitive symptoms along with or after classic manifestations of Lyme disease. This may represent an infectious or postinfectious encephalopathy related to B. burgdorferi infection.

J Neuropsychiatry Clin Neurosci 13:500-507, November 2001

© 2001 American Psychiatric Press, Inc.

Felice A. Tager, Ph.D., Brian A. Fallen, M.D., John Keilp, Ph.D., Marian Rissenberg, Ph.D., Charles Ray Jones, M.D. and Michael R. Liebowitz, M.D.

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.

http://www.poughkeepsiejournal.com/saturday/opinion/stories/op032302s3.shtmI

Poughkeepsie Journal Saturday, March 23, 2002 Letters to the editor

In my psychotherapy practice, I have seen both adolescents and adults battling Lyme disease. If one or more family member is seriously ill, the effects on the family can be profound.

When the brain is affected, the patient's ability to succeed can be very limited. Adolescents who have problems with memory, concentration and other cognitive functions have difficulty learning. It is not clear to the adolescent, the parents, or the school exactly what is wrong, just that the student is not successful.

Studies published in psychiatric and medical journals have documented the complexities of Lyme. There have, however, been few that focused on adolescents.

Patrick McAuliffe, a doctoral candidate at Columbia University Teacher's College, has begun a study on the cognitive effects of Lyme disease in adolescents. His adviser for the study is Dr. Brian Fallen, a noted Lyme researcher.

Neuropsychological testing will be provided without charge to adolescents who qualify. Study results could help schools better understand the cognitive deficits these young people may have, thus promoting their school success. In addition, it could contribute significantly to professional literature, filling a gap that exists in our understanding of this complex illness, and how it affects our adolescents.

Sandra K. Berenbaum, CSW-R, BCD, Wappingers Falls