Immunologic Reactivity Against Borrelia burgdorferi in Patients With Motor Neuron Disease

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Abstract
• 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 toBorrelia burgdorferi; 4 of 38 matched controls were seropositive. Eight of 9 sero-positive 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 burgdorferiantibody. 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 toB burgdorferi, at least among men living in hyperendemic areas.

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