ABSTRACT
The purpose of this study was to delineate distant neurological and neuropsychological effects of severe neuroborreliosis. A group of 33 patients (12 men and 21 women) were selected for the study. Every patient had suffered from severe meningitis, meningoencephalitis or meningopolyradiculoneuritis due to neuroborreliosis in the chronic form of the illness. Standardised medical interview, physical examination and a series of neuropsychological tests (WAIS-R, BDI, BENTON-BENDER, DUM) were performed. In the clinical history, 36.4% of the patients complained of headache, 27.3% of subjective memory distortions; 33.3% of the patients suffered from sleeplessness. The neurological examination showed that 36.4% of the patients experienced such cerebellum integrity disturbances as abnormalities in gait and coordination or even mild ataxia. 21.2% of the patients experienced dysfunction in the proprioceptive pathways, 9% asymmetry in deep tendon reflexes (DTR's), 27.3% disturbances in the sensory responses. The examination showed, however, no muscular strength abnormalities. Half of the patients had slight depression. Psychological tests indicated that 21.2% of the patients had problems in thinking process and experienced memory impairment. 36.4% of the patients had significant organic damage in the central nervous system. The results of this study suggest the existence of long-lasting consequences of acute neuroborreliosis, which can significantly influence the quality of life of patients.
Subject(s)
Lyme Neuroborreliosis/complications , Nervous System Diseases/etiology , Adult , Borrelia burgdorferi Group , Female , Humans , Lyme Neuroborreliosis/physiopathology , Lyme Neuroborreliosis/psychology , Male , Middle Aged , Nervous System Diseases/psychology , Neurologic Examination , Neuropsychological TestsABSTRACT
The diagnosis and treatment of neurological diseases in primary health care requires not only the specialistic knowledge but also easy access to the diagnostic and rehabilitation procedures and co-operation with neurologist. The aim of this study was to specify the quality of diagnosis and treatment of the neurological diseases in primary health care. The knowledge and practical skills of physicians working in the primary health care were analysed paralell to their possibilities of the diagnostics and rehabilitation of the patients suffering from neurological disturbances. Furthermore the quality of the co-operation with specialised neurologist was assessed. The research was carried on in 1999 using anonymous inquiry in the group of 151 primary health care (p.h.c.) physicians participating in the teaching courses in the Institute of Agricultural Medicine in Lublin. The research proved that patients with disturbances of the nervous system were frequently admitted to the primary health care outpatient departments. Among the diseases the low back pain, headaches and dizziness dominated. Most of the p.h.c. physicians used to examine patients by themselves but were sceptical about their skills. They tried to diagnose the neurological problems according to their abilities. The final effect was satisfactory, however neurological diseases treated by p.h.c. physicians were limited to the low back pain, headache, zoster and the febrile seizures. Only small percentage of patients was treated properly and in accordance with new trends in neurological art. Also the co-operation between primary health care physician and neurologist was not satisfactory.
