Neurological Dysfunction Olfactory

[Olfactorymessup]

In 07 began with a 7 day long episode of smelling cigarette smoke, only it was not there & I hate smoke. month later it came back worse, lasting 12 days & my mood was affected as well. Next month it lasted 14 days with several other symptoms, night twitching, brain fog, night sweats, confusion episodes while driving and not knowing where I was, sharpe pains in isolated spots in my head, vision changes in one eye, fatigue, bottom of lip numbness, neck stiffness mostly on right side and Mild headache, but ok with tylenol. Then, I had a blood test and it showed Lyme disease and the only rash I recall was in 2005. I began to have odd symptoms that year as well, head buzzing, not ringing, motion sickness easily in the car as a passenger, iritis in left eye, neck stiffness, sinus infection more frequently, muscle weakness, mood changes (grumpy). 2007 I had an abnormal 48 hr EEG, one Neuro says it could be seizures, the other says infection, and another says don't know but probably artifact. It showed 69 occurances in the 48 hours from various locations in my brain. My MRI was ok but mentioned a possible artifact near each ear. Will cont post on next entry....

[Esteban Cheng-Ching, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat it. However I will try to provide you with some useful information.
You have been experiencing multiple symptoms, and it is difficult to put them together just from your description.
Regarding Lyme disease, it can certainly produce neurologic problems. Lyme disease is a tick-borne illness caused by a spirochete called Borrelia. Lyme has multiple clinical manifestations and different phases. An early localized phase characterized by the skin lesions. An early disseminated phase with some more constitutional symptoms, and sometimes neurologic or cardiac manifestations.  A late phase in which patients complain of arthritis and sometimes neurologic manifestations like neuropathy or encephalopathy.
The diagnosis of Lyme can be based on clinical information if there is a typical skin rash and a distinction of the phases, and it can be supported with blood tests showing antibodies. However the diagnosis should not be made based only on blood serologic testing. Patients presenting with neurologic manifestations can have neuropathies either peripheral or cranial nerves, lymphocytic meningitis, encephalitis among others. To make the diagnosis a spinal tap is usually required to determine the production of antibodies in the CSF, as well as increased cellularity in the CSF. Depending on the type of manifestation of Lyme, the antibiotic regimen may change.
With your description I cannot tell you if you have Lyme or not, and I am not sure if you had a spinal tap to confirm the diagnosis, or if it was considered necessary.
Regarding the olfactory manifestations, negative symptoms (lack of smell or decreased ability to smell) is not necessarily a neurologic problem, as can be seen with abnormalities in the nasal cavity. However positive phenomena like the sense of smelling when the smell is not there, is most likely neurological. It is common as an aura and associated with seizures, and this is the most important condition to be ruled out. EEGs and MRIs are needed for the evaluation of seizures, however sometimes when the phenomena or when the seizure is not happening, the EEG can be unremarkable. Without being able to analyze your EEG or see your MRI, I cannot really know what the problem is, or what the abnormality or “occurance” was that you describe.
Based on this I cannot determine if you have seizures or not, and if your problem with smelling is associated with a seizure disorder. I think that you should discuss your concerns with your neurologist. If there is any further questions, getting a second opinion with a neurologist specialized in epilepsy may be helpful.
I hope this information is useful.

[Olfactorymessup]

I just saw another Neuro & he labeled me with Neurological Dysfunction and wants to put me on Depakote. I don't want to take meds for a dysfunction they cannot identify. I was treated for a year with antibiotics orally then IV for Lyme. I finished the IV in August and never had another episode till now. Could it be the Lyme? We all thought that this was all due to the lyme infection, and with the oral abx symptoms were less and the IV no symptoms for 6 months. Now, he wants to put a band aid on it with meds, without finding the cause and what it really is. Is this normal in Neurology? I am an RN, and so turned off by the medical community at this point. What is the harm with another EEG or MRI or something else that may give insight? What if it is an infection and I am taking depakote! Won't work! What screening tests can be done to r/o infection, or locate the exact problem as to what the dysfunction is?