Robert C. Bransfield, MD, DLFAPA Relationship of Inflammation and Autoimmunity to Psychiatric Sequelae in Lyme Disease. Psychiatric Annals. September 2012 - Volume 42 · Issue 9: 337-341. DOI: 10.3928/00485713-20120906-07.
http://www.healio.com/
Although controversies exist, there is a general consensus that most symptoms associated with Lyme/tick-borne disease are immune mediated. A progressive sequence of immune effects is associated with a progressive development of cognitive, psychiatric, neurological and somatic symptoms. These progressive immune effects include persistent inflammation with cytokine effects and the release of proinflammatory lipoproteins from the outer coat of Borrelia burgdorferi (Bb) and autoimmunity. In addition there are most likely other immune effects from the other tick-borne coinfections and opportunistic infections. Infection in the periphery can provoke immune activity that cross the blood brain barrier and impact mental functioning. Proinflammatory cytokines associated with Lyme/tick-borne infections cause sickness syndrome with fatigue and cognitive impairments.
Persistence of inflammation is associated with changes in tryptophan catabolism with increases in quinolinic acid resulting in depression and other mood and behavioral symptoms. Prolonged inflammation, particularly associated with chronic infection within the central nervous system is associated with further cognitive impairments, more severe psychiatric symptoms, glisosis and dementia.
Autoimmune effects can also be present at the same time and can include anti-neuronal antibodies and Bb lipoproteins which can disseminate from the periphery to inflame the brain. These immune reactions can result in psychiatric symptoms including intrusive symptoms, obsessiveness, movement disorders, paranoia and other symptoms.
Autism spectrum disorders associated with Lyme/tick-borne diseases appears mediated by a combination of inflammatory and autoimmune mechanisms from the mother’s and/or infant’s immune system. Understanding this pathophysiology creates new treatment options......
