Opsoclonus in Lyme Disease: Erratic Eye Movements in a Child

Opsoclonus—rapid, uncontrolled eye movements—is a rare neurologic manifestation of Lyme disease.

Opsoclonus is typically associated with infection or malignancy, particularly neuroblastoma. However, it has rarely been reported in Lyme disease, explain Gibaud and colleagues in a case report “Opsoclonus in a child with neuroborreliosis.” [1]

To date, only a few cases have been described in the medical literature.

Case Presentation

A child presented with erratic, rapid eye movements consistent with opsoclonus.

Lyme disease was diagnosed based on:

• Facial nerve palsy
• Abnormal spinal tap
• Supportive Lyme serologic testing
• Absence of malignancy
• Rapid response to antibiotic therapy

Treatment and Outcome

The patient was treated with a 3-week course of intravenous ceftriaxone.

Symptoms completely resolved following antibiotic treatment.

Opsoclonus-Myoclonus Syndrome (OMS)

Opsoclonus may occur alone or as part of opsoclonus-myoclonus syndrome (OMS), which includes myoclonus and ataxia.

OMS has also been reported in Lyme disease. Peter and colleagues suggest that Lyme disease should be included among conditions evaluated in OMS.

For more neurologic manifestations, see neurologic Lyme disease and eye problems in Lyme disease.

Clinical Perspective

This case highlights the importance of considering Lyme disease in children with unexplained neurologic symptoms, including abnormal eye movements.

Early recognition is critical, as appropriate antibiotic treatment may lead to full recovery.

Clinical Takeaway

Opsoclonus is a rare but treatable neurologic sign of Lyme disease in children.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention