Immunologic reactivity against Borrelia burgdorferi in patients with motor neuron disease
J. J. Halperin, G. P. Kaplan, S. Brazinsky, T. F. Tsai, T. Cheng, A. Ironside, P. Wu, J. Delfiner, M. Golightly, R. H. Brown and al. et
Department of Neurology, State University of New York, Stony Brook 11794.
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
seropositive 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.
