Source: DGNews  |  Posted 2 years ago

By Andrew Wilner, MD

SEATTLE, Wash -- May 2, 2009 -- Intravenous immunoglobulin (IVIG) therapy may improve neuropathic symptoms in patients with post-treatment Lyme syndrome, researchers stated here on April 28 at the American Academy of Neurology (AAN) 61st Annual Meeting.

A significant number of patients who had Lyme disease will continue to have lingering symptoms referred to as post-treatment Lyme syndrome, according to presenter Amiram Katz, MD, Lambert Professional Center, Orange, Connecticut. Similar symptoms are seen in patients who have received the Lymerix vaccine.

The study included 30 patients seen by Dr. Katz (13 females, 17 males; mean age 48.2 years) who complained of neuropathic pain.

Of the patients, 22 had a history of Lyme disease and 8 patients had received the Lymerix vaccine. All patients had antibodies to outer surface protein A (anti-OspA) and persistent symptoms despite at least 1 course of antibiotics.

Twenty-four patients had electrodiagnostic studies, but there was a poor correlation between electrodiagnostic and nerve biopsy results.

Four patients with abnormal electrodiagnostic studies had normal epidermal nerve fibre density on nerve biopsy, while 10 patients with normal electrodiagnostic studies had abnormal epidermal nerve fibre density on nerve biopsy. Three patients had inflammatory changes around the nerve endings on skin biopsy.

All patients were treated with IVIG 2 g/kg per month for at least 6 months.

After IVIG treatment, all patients had improvement of their neurological examination with respect to their sensation, Achilles reflex, and Romberg test. Several patients also showed improvement in the number of nerve fibres on repeat nerve biopsy after treatment. There was no placebo group.

“The diagnosis of chronic Lyme disease is not widely accepted, yet these patients have symptoms and nerve biopsies that respond to IVIG treatment, legitimising their complaints,” concluded Dr. Katz.

[Presentation title: Diminished Epidermal Nerve Fiber Density in Patients With Antibodies to Outer Surface Protein A (OspA) of B. burgdorferi Improves with Intravenous Immunoglobulin Therapy. Abstract P02.021]