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Lyme disease is a tick-borne illness that can affect multiple organs and body systems. In some cases, Lyme disease impacts the central nervous system (CNS) in what’s known as neurologic Lyme disease (NLD). Neurologic Lyme disease can cause symptoms closely resembling those of multiple sclerosis (MS).

The similarity in these symptoms leads some people with MS to wonder whether they have Lyme disease as well. Some seek testing for the presence of antibodies against the Lyme infection to determine what’s causing their symptoms.

There are several key differences between Lyme disease and MS. If you suspect you have either condition, it is important that you seek prompt medical attention and diagnosis. Treating Lyme disease with antibiotics as early as possible can help prevent the illness from progressing.

What Are Lyme Disease and Multiple Sclerosis?

Lyme disease was named after Lyme, Connecticut, where the illness was first identified. Lyme disease is caused by the spirochete (spiral-shaped) bacterium Borrelia burgdorferi. Lyme is a seasonal tick-borne infection — it is contracted from the bite of a deer tick carrying the bacteria.

In about 15 percent of cases, B. burgdorferi affects the central nervous system, which is what causes neurologic Lyme disease. NLD is the form of the Lyme disease that may be confused with MS, as it causes neurologic symptoms that can resemble the symptoms of multiple sclerosis. Unlike multiple sclerosis, however, Lyme disease can often be treated with antibiotics if caught early on.

Multiple sclerosis is a chronic autoimmune disease in which the immune response targets the CNS, including the brain and spinal cord. In people with MS, the body’s defenders (white blood cells) attack the central nervous system, causing inflammation and stripping nerves of their protective coating, called myelin. Over time, this damage — called demyelination — can cause people with MS to experience a variety of symptoms that affect physical movement, eyesight, and cognitive (mental) functioning.

Multiple sclerosis is long-lasting and has no known cure. Conversely, most cases of Lyme disease can be cured using a two- to four-week course of oral antibiotics. The disease must be caught when the infected individual has erythema migrans, the characteristic bull’s-eye rash that develops in the early stages of Lyme. That said, some people with Lyme disease who have received antibiotic treatment may go on to develop chronic symptoms. This is known as post-treatment Lyme disease syndrome or chronic Lyme disease.

Symptoms of Lyme Disease and MS

Both Lyme disease and multiple sclerosis can cause a variety of neurologic symptoms, including:

• Weakness
• Confusion
• Cognitive problems
• Fatigue
• Pins and needles sensations

Lyme and MS also may both cause optic neuritis — inflammation in the optic nerve responsible for transmitting visual information from the eye to the brain. This can result in problems such as blurred or double vision.

Neurological symptoms are not the initial symptom of Lyme disease. Those are often delayed, developing anywhere from several days or weeks to months after a person has been infected with B. burgdorferi bacteria. Lyme disease can affect other body parts as well, such as the joints.

In some cases, Lyme disease may also cause symptoms that relapse (return or worsen) and remit (disappear or improve). The same is true of the form of multiple sclerosis known as relapsing-remitting MS. Lyme disease has even been known to trigger multiple sclerosis attacks (flare-ups), which may complicate differentiating between the two conditions.

Differences in Symptoms

The main difference between MS and Lyme disease is that Lyme disease causes a characteristic rash known as erythema migrans. The classic Lyme disease rash presents after the initial tick bite with a clearly defined bull’s-eye or target shape, featuring one central red spot encircled with expanding rings. Some people may develop lesions that do not have clearly defined rings. Others may have a rash with crusting or a red-blue color.

Erythema migrans | Image courtesy of DermNet

Diagnosing Lyme Disease and MS

Some of the effects of Lyme disease and MS can be seen in imaging tests. Lyme disease may sometimes lead to abnormalities similar to those seen in people with MS on MRI brain scans and analysis of the cerebrospinal fluid.

If you are unsure about your symptoms, see a neurologist who is specially trained to know the differences between MS and Lyme disease. Neurology experts will be able to perform tests used to diagnose the two conditions, such as:

• Blood tests
• MRI scan
• Lumbar puncture (also known as a spinal tap)
• Enzyme-linked immunosorbent assay test, or a Western blot test, which checks for the presence of antibodies to B. burgdorferi

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Have your MS symptoms ever been confused with Lyme disease? Share your experience with other members by leaving a comment below, or by posting on MyMSTeam.