Dr. Richard Horowitz, M.D.'s Lyme-MSIDS Questionnaire
An Essential Tool in Determining the Probability of Lyme Disease and MSIDS
Take the Horowitz Lyme-MSIDS Questionnaire on Tired of Lyme
Section 1: Symptom Frequency Score
Input the frequency of each of the following symptoms.
1. Unexplained fever, sweats, chills, or flushing
2. Unexplained weight change; loss or gain
3. Fatigue, tiredness
4. Unexplained hair loss
5. Swollen glands
6. Sore throat
7. Testicular or pelvic pain
8. Unexplained menstrual irregularity
9. Unexplained breast milk production; breast pain
10. Irritable bladder or bladder dysfunction
11. Sexual dysfunction or loss of libido
12. Upset stomach
13. Change in bowel function (constipation or diarrhea)
14. Chest pain or rib soreness
15. Shortness of breath or cough
16. Heart palpitations, pulse skips, heart block
17. History of a heart murmur or valve prolapse
18. Joint pain or swelling
19. Stiffness of the neck or back
20. Muscle pain or cramps
21. Twitching of the face or other muscles
23. Neck cracks or stiffness
24. Tingling, numbness, burning, or stabbing sensations
25. Facial paralysis (Bell's palsy)
26. Eye/vision: double, blurry
27. Ears/hearing: buzzing, ringing, ear pain
28. Increased motion sickness, vertigo
29. Light-headedness, poor balance, difficulty walking
31. Confusion, difficulty thinking
32. Difficulty with concentration or reading
33. Forgetfulness, poor short-term memory
34. Disorientation: getting lost; going to wrong places
35. Difficulty with speech or writing
36. Mood swings, irritability, depression
37. Disturbed sleep: too much, too little, early awakening
38. Exaggerated symptoms of worse hangover from alcohol
Section 2: Most Common Lyme Symptoms Score
If you rated a 3 for each of the following symptoms in section 1, give yourself 5 points for each one you did.
40. Forgetfulness, poor short-term memory
41. Joint pain or swelling
42. Tingling, numbness, burning, or stabbing sensations
43. Disturbed sleep: too much, too little, early awakening
Section 3: Lyme Incidence Score
Now for each of the following statements that is true, give yourself the point value found at the end of the statement. If a statement is false, click the box to generate a "0".
44. You have had a tick bite with no rash or flulike symptoms. (3 points)
45. You have had a tick bite, an erythema migrans, or an undefined rash, followed by flulike symptoms. (5 points)
46. You live in what is considered a Lyme-endemic area. (2 points)
47. You have a family member who has been diagnosed with Lyme and/or other tick-borne infections. (1 points)
48. You experience migratory muscle pain. (4 points)
49. You experience migratory joint pain. (4 points)
50. You experience tingling/burning/numbness that migrates and/or comes and goes. (4 points)
51. You have received a prior diagnosis of chronic fatigue syndrome or fibromyalgia. (3 points)
52. You have received a prior diagnosis of a specific autoimmune disorder (lupus, MS, or rheumatoid arthritis) or of a nonspecific autoimmune disorder. (3 points)
53. You have had a positive Lyme test (IFA, ELISA, Western blot, PCR, and/or borrelia culture). (5 points)
Section 4: Overall Health Score
54. Thinking about your overall physical health, for how many of the past 30 days was your physical health not good?
55. Thinking about your overall mental health, for how many of the past 30 days was your mental health not good?
Your total scores for each section are recorded below. Click "calculate" to add them together to achieve your final score.
Not all input boxes are filled. If no value, click the box to generate a "0".
Final Score: Under 21
If you scored under 21, you are not likely to have a tick-borne disorder.
Final Score: Between 21 and 45
If you scored between 21 and 45, you possibly have a tick-borne disorder and should see a health-care provider for further evaluation.
Final Score: 46 or more
If you scored 46 or more, you have a high probability of a tick-borne disorder and should see a health-care provider for further evaluation.