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What Causes Numbness In Limbs And Face When Diagnosed With Lyme Disease?
Question: Hello. I was diagnosed with lyme disease three years ago. My first symptoms included numbness in toes and feet and arthritis in the knees. I received treatment and all of the symptoms went away. The numbness in my feet and hands has returned with a great severity. I went on antibiotics for 6 months. 5 out of the 6 months the symptoms went away. I went to the doctor and the blood work read all is well for liver and B vitamins. However, the lyme disease test showed reactive and positive for lyme. The doctor didn't want to continue antibiotics. I am now 4 weeks off the antibiotics and the numbness in feet and hands has returned. I now have numbness on the right side of my face. The doctor wishes to treat with gabapentin for the facial numbness. I think I should be on an IV antibiotic for lyme as I think its the cause for the symptoms. Can you provide some guidance as to why my face is numb?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It seems that yours is a case of late or persistent Lyme disease. It is a difficult to treat condition in which usage of antibiotics and length may vary between physicians. The blood tests which you mention for Lyme aren't really reliable for Lyme as antibodies may remain in the blood for long after the infection is gone, their presence doesn't necessarily indicate infection. Furthermore some healthy people may present such antibodies as well as people with autoimmune conditions like rheumatoid arthritis or lupus. So decisions shouldn't be taken based on these neurologic tests.
You say that you were continuously treated with same antibiotic for 6 months, that I must say I can't say I can agree with. A course of therapy usually consists for 2-4 weeks. Even in course of persistence or recurrence a repeat course is recommended for 4 weeks. It is not continued so long especially since you say symptoms regressed. Whether these additional weeks should have been oral or intravenous, both options are accepted, can't contest oral option being used, it is the length which leaves me perplexed.
Now your current recurrence. At times numbness in feet and hands may persist as part of the post Lyme syndrome or permanent damage to peripheral nerves and in that case Gabapentin is a correct choice as antibiotics are not expected to do much about that. However in front of also a new sign such as your facial numbness one must be prudent before leaving it at that. That is because involvement of nervous system can present with involvement of cranial nerves, nerves supplying the face as well. So that is one possibility to be investigated as it would be an indication for iv antibiotics, orals do not suffice. For that purpose I believe a lumbar puncture and MRI imaging are also necessary to investigate for involvement. If they result negative and there are no other manifestations (neck rigidity, facial palsy, headache etc) then I would recommend no antibiotics only Gabapentin. If positive or other manifestations then iv antibiotics are necessary.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
It seems that yours is a case of late or persistent Lyme disease. It is a difficult to treat condition in which usage of antibiotics and length may vary between physicians. The blood tests which you mention for Lyme aren't really reliable for Lyme as antibodies may remain in the blood for long after the infection is gone, their presence doesn't necessarily indicate infection. Furthermore some healthy people may present such antibodies as well as people with autoimmune conditions like rheumatoid arthritis or lupus. So decisions shouldn't be taken based on these neurologic tests.
You say that you were continuously treated with same antibiotic for 6 months, that I must say I can't say I can agree with. A course of therapy usually consists for 2-4 weeks. Even in course of persistence or recurrence a repeat course is recommended for 4 weeks. It is not continued so long especially since you say symptoms regressed. Whether these additional weeks should have been oral or intravenous, both options are accepted, can't contest oral option being used, it is the length which leaves me perplexed.
Now your current recurrence. At times numbness in feet and hands may persist as part of the post Lyme syndrome or permanent damage to peripheral nerves and in that case Gabapentin is a correct choice as antibiotics are not expected to do much about that. However in front of also a new sign such as your facial numbness one must be prudent before leaving it at that. That is because involvement of nervous system can present with involvement of cranial nerves, nerves supplying the face as well. So that is one possibility to be investigated as it would be an indication for iv antibiotics, orals do not suffice. For that purpose I believe a lumbar puncture and MRI imaging are also necessary to investigate for involvement. If they result negative and there are no other manifestations (neck rigidity, facial palsy, headache etc) then I would recommend no antibiotics only Gabapentin. If positive or other manifestations then iv antibiotics are necessary.
I remain at your disposal for other questions.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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