Subacute parkinsonism as a complication of Lyme disease

Medicine is always on the lookout for reversible causes of common illnesses. And while parkinsonism has been reported in a few patients with Lyme disease, the relationship between the Borrelia burgdorferi (Bb) infection and parkinsonism has been questioned. In the review “Subacute parkinsonism as a complication of Lyme disease,” published in the Journal of Neurology, the authors describe two cases where patients “developed reversible subacute parkinsonism due to Lyme basal ganglia ischemic or inflammatory lesions.”

 

by Daniel J. Cameron, MD MPH

The article describes a 55-year-old patient with a 2-month history of chronic neck pain with progressive marked asthenia. “Clinical examination revealed a dysarthria which disappeared in less than 1 hour, a left upper limb cerebellar ataxia and a bilateral asymmetric mild akineto-hypertonic parkinsonism,” according to Pische´ from the Department of Neurology, CHRU Strasbourg, Strasbourg Cedex, France. [1]

The second case involves a 63-year-old woman who developed a rapidly deteriorating severe walking disorder over a 6-month period. “Clinical examination revealed lower limbs weakness, increased reflexes, bilateral extensor plantar, and dysuria, as well as a left akineto-hypertonic syndrome.” Facial palsies were also described.

Brain MRIs showed vascular demyelination, typically seen in inflammatory, infectious, drug induced, or paraneoplastic vasculitis conditions.

Physicians suspected both patients suffered from neuroborreliosis. They each presented with an abnormal DaTscan, a specialized imaging technique that allows doctors to capture detailed pictures of the dopamine neurons in your brain.

“In both cases, DaTscan demonstrated apresynaptic dopaminergic denervation which has been associated with striatal ischemic lesions due to Lyme probable vasculitis,” explains Pische´.

The DaTscan (GE) has been used in Parkinson’s disease to “allow physicians to provide accurate clinical management of the patient and prevention of unnecessary medications and procedures,” says Seifert from Florida Atlantic University. [2]

Both patients, presenting with subacute parkinsonism and an abnormal DaTscan, were diagnosed and treated successfully for Lyme disease. “The two patients reported here, who developed, fulfilled the diagnostic criteria for neuroborreliosis: no past history of neuroborreliosis, positive anti-BB antibody index, favorable outcome of neurological signs after specific antibiotic treatment, and absence of other diagnosis,” according to Pische´. [1]

The first case of subacute parkinsonism resolved with a 21-day course of 2 g per day of ceftriaxone without the need for dopaminergic treatment. The second patient required a second 21-day round of ceftriaxone, along with 3 months of corticosteroid therapy (60 mg/day) and Ldopa/carbidopa (300 mg/day).

Acute or subacute parkinsonism, according to the authors, can be a complication of Lyme disease, as demonstrated in these two cases. Therefore, Lyme disease should be discussed when patients living in endemic areas present with basal ganglia MRI lesions.

“In front of an acute or subacute parkinsonism, especially in endemic region, neuroborreliosis should be discussed in case of associated headache, multisystemic neurological signs, or MRI basal ganglia vasculitis or inflammatory signs.”

The authors cautioned, “Lyme blood or CSF serology should not be asked for, even in endemic region, in case of progressive parkinsonism without any basal ganglia MRI lesions.”

References:

  1. Pische G, Koob M, Wirth T et al. Subacute parkinsonism as a complication of Lyme disease. J Neurol, (2017).
  2. Seifert KD, Wiener JI. The impact of DaTscan on the diagnosis and management of movement disorders: A retrospective study. Am J Neurodegener Dis, 2(1), 29-34 (2013).


6 Replies to "Subacute parkinsonism as a complication of Lyme disease"

  • Sally Dant
    04/19/2017 (1:32 am)
    Reply

    I have had Lyme since 1996. First big episode in 2001. Went to LLMD, treated for 1.5 year with oral abx. DR. B protocol.
    In 2003 had MRI done and in the results it noted the following.
    There is minimal subtle periventricular increased signal in the periventricular white matter, particularly adjacent to the occipital horns of the lateral ventricle and in the temporal -occipital regions. Several tiny periventricular spaces are noted in the basal ganglia.
    Does this correlate with this article?

    • Dr. Daniel Cameron
      04/19/2017 (7:03 am)
      Reply

      This paper reminds doctors on the difficulties interpreting the causes of specific finding on scans. I encourage my patients to seek consultation with specialists to weight different diagnosis and treatment options.

  • Marta Sanimill
    04/19/2017 (2:34 am)
    Reply

    Having Lyme, and have gone through 30 days of dioxacycline(SP), then after 30 days of intravenus antibiotic because of Bundle branch block as Lyme attacked one chamber of my heart. I am now experiencing parkinsonian like symptoms with electric shocks racking my body, extreme imsomnia, extreme restless leg syndrome, and at times in full body shakes. They come and go however the electric choks continue inrelentingly. I need help. No one understands. The ER actually wanted to give me a mental consult.

  • Vuokko Virta
    04/19/2017 (5:50 am)
    Reply

    I am wondering when these diagnoses will collapse: Multiple Sclerosis, Parkinsons Disease, ALS, Chronic Fatigue Syndrome, Fibromyalgia ? They only describe how the patient presents with his symptoms ! There is not a clue about the cause!

  • John Coleman ND
    04/19/2017 (6:45 am)
    Reply

    In my practice, approximately 30% of my patients diagnosed with Parkinson’s by registered neurologists have tested positive to Borrelia infection.

  • Elaine
    04/20/2017 (4:27 pm)
    Reply

    Marta – I know how you feel. I am an otherwise healthy 59 yr old. My dad lived to be 93 years old and my mom is still alive at 93 years old. I have not been diagnosed yet but Gait Ataxia and Parkinsonism have been mentioned. Sometimes I just need some relief. I am scheduled for my 2nd MRI in a couple of weeks. I will see what they have to say then.


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