Dysfunction of the Atlaido-occipital Joint
The atlaido-occiopital joint has been reported to be another common and clinically significant site for symptoms [71]. The structural change of the ligaments which fix the atlas to the base of the skull [alar ligaments] or stabilise the dens axis [transverse atlantis liagments], have special significance owing to their complex effects on cranio-mandibular function, vegetative control through sympathetic and parasympathetic nerves, the function of various centres of the brain stem, the induction of increased nitrogen oxide and peroxynitrite formation [72, 73], increased production of pro-inflammatory cytokines and cyclooxygenases [74], and finally also due to dislocation of vertebrae and intervertebral discs and accompanying myopathies [72].
Dysfunction of the atlaido-occipital joint without traumatic damage but correlated to chronic Lb has been described inducing a variety of symptoms [71]. 12 [18,8%] of the 64 patients reported had positive IgG antibodies in ELISA and 17 [26,6%] in immunoblot. IgM antibodies had not been found in any of the cases. In 57 (89,1%) patients the stimulation index (SI) in lymphocyte transformation test (LTT) was pathologically increased (SI > 3,0) in one of the four antigens investigated (B. burgdorferi, B. afzelii, B. garinii, Ospc). A functional magnetic resonance imagin (MRI) scan was carried out on 28 (49,1 %) of the 57 patients with pathological SI in LTT. Structural damage has been described to the alar ligament, the transverse axis ligament included involvement of the spinal cord medulla with mechanically triggered myelopathy as it has been reported in cases following traumatic damage [75]. As published before [76], the number of CD57+ natural killer cells (NK-cells) was determined. 36 (78,3 %) of the examined 46 patients
showed significant reduction of this cell type.