From the Guidelines
Brisk reflexes can be associated with both Lyme disease and Epstein-Barr virus (EBV) infections, although the evidence is more robust for Lyme disease. In Lyme disease, neurological involvement can lead to hyperreflexia (overly brisk reflexes) as part of Lyme neuroborreliosis, which typically occurs in later stages of the disease when the bacteria have spread to the nervous system 1. The guidelines for diagnosing and treating Lyme disease, as outlined by the Infectious Diseases Society of America, highlight the importance of prompt antibiotic treatment to prevent long-term neurological complications, including hyperreflexia 1.
For EBV, brisk reflexes may be observed during the acute phase of infection, particularly in cases of EBV-associated encephalitis or myelitis, although this is less common than with Lyme disease 1. The proposed guidelines for diagnosing chronic active EBV infection emphasize the importance of accurate diagnosis and underlying disease identification, which may include neurological manifestations such as brisk reflexes 1.
It's essential to note that while brisk reflexes can occur with these infections, they are not specific diagnostic criteria. A thorough clinical examination, patient history, and appropriate laboratory tests are necessary for accurate diagnosis. Other neurological symptoms and signs should also be evaluated. If brisk reflexes are observed, further neurological assessment is warranted, which may include additional reflex testing, sensory examinations, and potentially imaging studies or lumbar puncture, depending on the clinical presentation.
The presence of brisk reflexes in these conditions is due to inflammation or damage to the central nervous system, affecting the normal inhibitory control of reflexes, which can result in an exaggerated response to reflex testing. Given the potential for long-term neurological complications, it is crucial to prioritize prompt and accurate diagnosis and treatment of both Lyme disease and EBV infections.
Key considerations for diagnosis and treatment include:
- Prompt antibiotic treatment for Lyme disease to prevent long-term neurological complications
- Accurate diagnosis and underlying disease identification for EBV infections
- Thorough clinical examination, patient history, and laboratory tests for accurate diagnosis
- Further neurological assessment, including reflex testing and imaging studies, if brisk reflexes are observed.
From the Research
Association with Lyme Disease
- Brisk reflexes can be associated with Lyme disease, as evidenced by a case study where a 64-year-old man presented with widespread weakness, atrophy, fasciculation, and brisk reflexes, which were later resolved with doxycycline treatment 2.
- Lyme disease can manifest with a range of neurological symptoms, including meningitis, radiculoneuritis, and facial palsies, making diagnosis challenging 3, 4.
- Neuroborreliosis, the involvement of the nervous system in Lyme disease, can cause various symptoms, including vertigo, dizziness, and balance instability, although these are relatively rare as sole presentations 5.
Association with Epstein-Barr Virus (EBV) Infection
- There is no evidence in the provided studies to suggest an association between brisk reflexes and EBV infection.
Comparison of Neurological Manifestations
- Lyme disease can mimic other neurological disorders, such as amyotrophic lateral sclerosis (ALS) or Guillain-Barré syndrome (GBS), highlighting the need for careful diagnosis 2, 4.
- The neurological manifestations of Lyme disease can be localized or diffuse, with central or peripheral involvement, making diagnosis and treatment challenging 3.