INSOMNIA ARTICLES - Personal Health; When Lyme invades the brain and spinal system.

INSOMNIA ARTICLES

Personal Health; When Lyme invades the brain and spinal system.

A YOUNG woman, whose doctor declined to identify her, thought she was going crazy. Suddenly, this once perfectly healthy college freshman developed severe anxiety, panic attacks, insomnia and loss of appetite.

A doctor and a psychologist at her college's health service recommended rest for what they thought were problems in adjusting to being away from home. Forced to take a medical leave, she underwent an extensive examination that showed no abnormalities except one: evidence in her spinal fluid of infection by the spirochete Borrelia burgdorferi, which causes Lyme disease. Only then did she recall having had a circular rash characteristic of Lyme disease months earlier, followed by a brief bout of headaches and unusual fatigue. At the time, she did not take these symptoms seriously and did not seek medical attention.

The young woman's case is among dozens reported in which the Lyme spirochete was the apparent cause of a wide range of psychiatric and neurological problems. Three months after receiving a six-week course of intravenous antibiotics to eradicate the spirochete, the woman felt better. But a year later more therapy was needed when the anxiety and panic attacks returned, along with musical hallucinations, deja vu experiences and obsessional thoughts.

Although such extreme cases are rare, neurological problems resulting from Lyme disease are more common than realized by most doctors, who tend to look for the more characteristic arthritic conditions associated with the disease. Nervous System Attack

When Lyme disease is promptly recognized and properly treated, the overwhelming majority of patients recover uneventfully. But often the initial sign of a bite by a Lyme-infected tick, a red circular rash that clears in the center, is not recognized. Only when more severe symptoms develop weeks or months later are a diagnosis and treatment pursued.

Meanwhile, within weeks of entering the body, the spirochete, a bacterium that resembles the organism that causes syphilis, can invade the brain and spinal cord. At first, patients may develop meningitis, encephalitis or problems like pain or loss of sensation stemming from an attack on the nerves that emanate from the brain or spinal cord. But as with syphilis, months or years may pass before the late signs of a neurological infection appear.

Once inside the central nervous system, the organism can wreak all kinds of havoc, from memory problems, moodiness and depression to hallucinations, panic attacks, paranoia, manic depression, seizures and even dementia. Memory problems are the most common sign of a brain infection. When the organism invades spinal nerves, patients may develop numbness and tingling in fingers and toes and pain radiating to the front of the body.

In rare cases, the spirochete may mount an attack on the protective sheath of nerves, resulting in spastic muscle weakness in the extremities that resembles multiple sclerosis, said Dr. Allen C. Steere of Tufts-New England Medical Center in Boston. Dr. Steere first recognized Lyme disease as a distinct disorder in 1975 and soon realized that it could cause neurological problems.

Dr. Brian Fallon, a psychiatrist at the State Psychiatric Institute in New York, recently reviewed the neuropsychiatric aspects of Lyme disease in The American Journal of Psychiatry, in the hope of prompting his colleagues to consider the possibility of this infection when examining patients who might have been exposed to Lyme-infected ticks.

In Europe, where the disease is called borreliosis, patients commonly develop neuropsychiatric symptoms after being infected by the same spirochete that causes Lyme disease, Dr. Fallon said. But in this country, arthritic symptoms are most common and many doctors still do not appreciate the threat to the nervous system.

Dr. Fallon said that up to 40 percent of patients with Lyme disease developed some involvement of the nervous system affecting either the extremities or the central nervous system. He told of a 47-year-old man who experienced depression and memory problems as his main signs of Lyme disease, symptoms that responded well to intravenous antibiotics. The symptoms recurred five months later, but he was not treated a second time. He developed a type of dementia that required hospitalization and died a few years later. An autopsy found Lyme spirochetes in a degenerated part of his brain.
Children can also develop a neurological form of Lyme disease that often shows up as behavioral or emotional disturbances. Such children may become moody, lose interest in play and do poorly in school. Among 16 children in Westchester County, N.Y., who contracted Lyme disease, 15 whose infections were identified and treated within the first month were doing very well, Dr. Fallon said. But one child, in whom the disease was not diagnosed until four months after he was thought to have been infected, has suffered for five years with arthritis, headaches, depression and memory problems.

Studies by Dr. Steere and others of patients with neurological signs of Lyme disease have revealed inadequate blood flow through particular areas of the brain. Dr. Steere also said that after an attack of Lyme disease, patients might develop pain or fatigue syndromes that resemble fibromyalgia or chronic fatigue syndrome. Diagnosis Problems

To be sure, extreme incapacitating effects of a Lyme infection are rare. But even the more subtle effects like depressed mood, memory problems and word-finding difficulties can be devastating to those who are afflicted.

Such patients commonly receive the wrong diagnosis or inappropriate treatment. Often they are shunted from one doctor to another. In addition to blood tests for antibodies to the spirochete, diagnosis of neurological Lyme disease may require a spinal tap, an electroencephalogram (EEG), magnetic resonance imaging (M.R.I.), standard neuropsychological tests (for example, for memory, word association and depression) and a carefully taken health history.

Even after a correct diagnosis is made and a long course of intravenous antibiotics is administered, the organism may not be eradicated from its sanctuary in the brain. Repeated courses of this costly therapy are typically needed, but many insurance companies balk at paying for them because the treatments are still considered experimental.

Sometimes the treatment itself can cause a flare-up of Lyme disease, producing both physical and neuropsychiatric symptoms. But most often, when the presence of a Lyme infection can be established, treatment with intravenous antibiotics for four to six weeks results in a distinct improvement. But Dr. Steere, who uses ceftriaxone, which is sold as Rocephin, noted that patients typically must wait three to six months to see signs of gradual improvement and may never recover 100 percent.


by Jane E Brody on The New York Times, published on Feb 15, 1995

INSOMNIA ARTICLES

It’s Not Just Apes; Fruit Flies Are Our Cousins, Too

As humans age, so I’m told, they tend not to sleep as well as they once did. There are all sorts of reasons — aches and pains, worries about work, and lifelong accumulations of sins that pretty much rule out the sweet sleep of innocence.

But what about fruit flies?

Not as a cause of insomnia. What about the problems fruit flies have sleeping? Yes, Drosophila melanogaster also suffer sleep disruption when they get older. And a report on the troubled sleep of drosophila is being published in The Proceedings of the National Academy of Sciences.

This is the kind of science that makes you wonder. For instance, are the female flies suffering from hot flashes? Are the male flies getting up to go to the bathroom three or four times a night? Of course not. Fruit flies don’t have bathrooms.

Or you may wonder what troubles are keeping the flies up. They don’t have to worry about family values, illegal immigration or debt. They don’t have families or money.

And given the ubiquity of fruit and of scientific research, I’m guessing drosophila, bless their little genomes, must benefit from something close to full employment.

What I wonder is why people waste time worrying about whether we evolved from animals. But they do.

As reported over and over again, a disconcerting number of Americans doubt the fact of evolution. The country seems almost evenly divided on the matter, according to a recent report in Science. Some of the worriers concentrate on apelike ancestors, showing a lack of vision. There are stranger connections to agonize over, like drosophila and beyond. We share sleep problems with fruit flies. We have a huge amount of DNA in common with yeast.

Those are our distant cousins we consume in leavened bread, our fellow multicelled organisms undergoing dreadful experiments in the drosophila lab.

For instance, scientists have heated up the ambient temperature in fruit flies environments to see what happens. At 64 degrees Fahrenheit they live twice as long as at 84 degrees. Live hot, die young.

What does that mean for us? We really do share a lot with drosophila. As the article in the Proceedings reports, fruit flies have sleep-wake cycles that become fragmented as they age, suffering a “loss of sleep consolidation, namely increased daytime sleep and increased nighttime wakefulness in the elderly,” as Kyunghee Koh at the Howard Hughes Medical Institute and three colleagues describe it.

Sound familiar? It should. Some of the same genes related to circadian rhythms occur in humans and in flies. Mutations in some of these shared clock genes can cause sleep disorders in people.

We also share genes related to learning and alcohol sensitivity. But even these commonalities are not worth worrying about. The genes are just details. We have the same basic cell machinery — DNA, for example — with everything living. Broccoli rabe for instance, is known to have DNA. You may find it bitter, but you still share an evolutionary history with it.

The bacteria in my gut accounts for more genes than I have in my chromosomes. We not only have a lot in common with microbes, in a way that is only beginning to be understood, we are microbes.

This is fine with me. I’m delighted to be related to flies, yeast, frogs, chimps and blue-green algae. I find the serenity of algae restful and the ambition of yeast admirable. Frogs are great jumpers. Chimps have hands at the end of their feet, sort of. And fruit flies, well, I never met a fruit fly that I was ashamed to share genes with, and I certainly can’t say that about human beings.

Watch the news. Read history. Be honest, if you could pick your relatives, would you choose this species?

By the way, Dr. Koh and colleagues don’t have a cure for age-related sleep disturbance — in flies or people. But I, for one, will rest easier knowing I’m not the only one lying awake at night. My drosophila cousins are probably up too.

I wonder what flies count when they can’t sleep — paramecia?

by James Gorman, published on Aug 22, 2006