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Differential Diagnosis in Lyme Disease by Brian A. Fallon, MD
“Two presentations today addressed the overlap that exists between similar disorders — one talk focused on diagnostic distinctions between fibromyalgia, Lyme disease, and Gulf War syndrome; the other was devoted to Chronic Fatigue Syndrome and Post-Lyme Disease.
Dr. Sam T. Donta of the Boston University Medical Center discussed fibromyalgia and Lyme disease, noting the increasing awareness of the similarities and differences between chronic Lyme disease and other chronic multi-symptom disorders (CMSDs) such as fibromyalgia, chronic fatigue, and Persian Gulf War illness. Still, since all are characterized by fatigue, musculoskeletal pain, and neurocognitive dysfunction, discriminating one from the others is often difficult.“
“Lyme Encephalopathy” Eric Logigian, M.D.
“Patients with Lyme encephalopathy generally complain of concentration and memory difficulty. In addition, there may be hypersomnolence characterized by a need to take naps during the afternoon or go to bed early in the evening. Mild psychiatric disturbance presenting as depression, irritability or paranoia may also develop. Patients may change their behavior to compensate for the memory disturbance, most commonly, by making extensive lists to keep track of all their affairs. Family members may notice that the patient forgets names of close friends or relatives and requires frequent repetition in order to learn new things. Functionally, most patients using compensatory methods can continue to work but this often requires intense and constant effort. About 25% of patients have to retire or reduce their workloads.”
“Several conditions should be considered in the differential diagnosis of Lyme encephalopathy. In the United States, the most common mistake is to confuse chronic fatigue syndrome with Lyme encephalopathy. Other causes for confusion are depression, normal aging with slight decrease in memory and early Alzheimer's disease.”
“Journal Watch - Lyme Disease May be Overdiagnosed” The overdiagnosis of Lyme disease, Steere AC et al, JAMA 1993 Apr 14; 269:1812-1816.
“Most patients were referred by their doctors. Only 23 percent met criteria for active Lyme disease: 14 patients had early disease and 163 had late disease. Arthritis and chronic encephalopathy or polyneuropathy were the most common manifestations. Another 20 percent of the referred patients had previously had Lyme disease; the remaining 57 percent had not. The most common illnesses in these two groups were chronic fatigue syndrome and fibromyalgia.”
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“Evening Primrose Oil (EPO) — Gamma-linolenic acid (GLA)”
“There has been a great deal of research with GLA in the last decade, much of it conducted in England where the majority of evening primrose oil is made. With close to 100 research papers published and many more in progress, the results are mixed. Most of the findings, though, are positive and promising, particularly in regard to clearing or reducing symptoms in arthritis, skin problems, and premenstrual syndrome, as well as for all kinds of inflammatory problems, cardiovascular disease, and immunodepression.”
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“Common Misconceptions About Quackery.” Stephen Barrett, M.D.
“Although most Americans are harmed by quackery, few perceive it as a serious problem and even fewer are interested in trying to do anything about it. Many misconceptions appear to contribute to this situation.”
“Quackery: How Should It Be Defined?” Stephen Barrett, M.D.
“To avoid semantic problems, quackery could be broadly defined as ‘anything involving overpromotion in the field of health.’ This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word fraud would be reserved only for situations in which deliberate deception is involved.”
“Chronic fatigue, chronic fatigue syndrome, and fibromyalgia. Disability and health-care use.” Med Care 34: 924-930 (1996); Bombardier CH, Buchwald D; Department of Rehabilitation Medicine, University of Washington, Seattle, USA.
“CONCLUSIONS: Chronic fatigue, CFS, and FM are associated with considerable personal and occupational disability and low rates of employment. The potentially large economic burden of these disorders underscores the need for accurate estimates of direct and indirect costs, the relative contribution of individual factors to disability, and the need to develop targeted rehabilitation programs.”
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