Lyme disease is a bacterial infection caused by the Borrelia burgdorferi sensu lato complex, transmitted by ticks, which can typically affect multiple systems. The neurological manifestations of the disease can appear at any stage of the disease course and present a clinically heterogeneous picture. Disturbances in tactile sensation, including tingling, numbness and loss of sensation, are one of the most common but often underestimated manifestations of peripheral nervous system involvement.
Normal tactile sensation requires the integrated functioning of afferent sensory fibres, peripheral nerves, dorsal roots, ascending spinal cord pathways and the sensory cortex. In Lyme disease, several of these levels may be affected, partly through direct bacterial invasion and partly through immune-mediated inflammatory mechanisms. As a result, sensory disturbances are not uniform, but may vary in location, intensity and duration.
The most common complaint reported by patients is a tingling, “pins and needles” sensation, known as paraesthesia. This sensation is typically intermittent, often migratory in nature, and does not necessarily follow a dermatomal pattern. According to clinical observations, paraesthesia most commonly occurs in the distal parts of the limbs, especially in the hands and feet, but it can also occur in the trunk or face. The phenomenon is most often caused by functional disorders of small and medium-sized sensory fibres.
Numbness, or reduced tactile sensation (hypoaesthesia), often appears as a progression of paraesthesia and indicates an objectively detectable sensory deficit. During neurological examination, reduced pain, heat or vibration perception can be observed, which is often symmetrical, showing a “glove-sock” distribution. This pattern is characteristic of axonal peripheral neuropathy associated with Lyme disease, which develops primarily due to the involvement of long nerve fibres.
Loss of sensation (anaesthesia or severe hypoaesthesia) indicates significant damage to sensory pathways and usually appears in the later stages of the disease. In patients with chronic Lyme disease involving the nervous system, it has been documented that sensory loss can extend beyond superficial touch to include deep sensation, which can lead to unsteady gait, proprioceptive disturbance, and falls. These symptoms are of particular clinical significance in older patients.
The pathophysiology of tactile perception disorders in Lyme disease is complex. Borrelia spirochetes are neurotropic and capable of persisting in nerve tissue. In addition, the inflammatory cytokine response and autoimmune processes that develop during infection also contribute to nerve damage. Histological and electrophysiological studies have confirmed that neuropathies associated with Lyme disease are often axonal in nature and less frequently show a demyelinating pattern, which distinguishes them from Guillain-Barré syndrome, for example.
Lyme meningoradiculitis (Bannwarth syndrome), in which inflammation of the nerve roots predominates, is a separate entity. In this case, tactile sensory disturbances are often dermatomal in distribution and associated with pronounced radicular pain. Patients report burning, stabbing pain and numbness or loss of sensation in the affected area. This condition is particularly common in Europe, where Borrelia garinii plays a dominant role in the development of neurological complications of Lyme disease.
The diagnosis of tactile perception disorders requires a complex approach. In addition to a detailed medical history and neurological examination, electrophysiological tests such as nerve conduction velocity measurements and electromyography play an important role. These help to distinguish Lyme disease-associated neuropathy from other common causes of nerve damage, such as diabetes mellitus, alcohol toxicity or vitamin deficiency.
From a therapeutic point of view, appropriate antibiotic treatment is essential. Tactile sensory disturbances often improve slowly, and regression of symptoms may take weeks or months even with successful antibiotic treatment. It is important to emphasise that persistent paraesthesias are not necessarily signs of active infection, but may also be residual symptoms.
In summary, tingling, numbness and loss of sensation associated with Lyme disease are common and clinically significant manifestations of peripheral and central nervous system involvement. These symptoms not only impair patients’ quality of life, but are also important diagnostic indicators that direct clinical thinking towards nervous system involvement in Lyme disease. Early detection and targeted antibiotic treatment are key to preventing permanent nerve damage, so a thorough examination of sensory disturbances is essential when Lyme disease is suspected.
Sources:
https://pubmed.ncbi.nlm.nih.gov/2168778/
https://pubmed.ncbi.nlm.nih.gov/1310529/
(C) Lyme Borreliosis Foundation
