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).


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JR
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JR

I just got a 2nd opinion at major University hospital and its suspected my parkinsons diagnosis may actually be neuro lyme. I have tremors especially in right arm and now have frozen shoulder as well. Cefdinir seems to be helping clear brain fog and fatique. Also on carbidopa but not really helping tremors yet. Tested positive for western blot lyme (two times once early and now again) and also positive anaplasma. Been on oral abx for two years and had 21 days of Rocephin early on. Docs suggest iv abx again or maybe ivig might help. Also suggested lumbar puncture.… Read more »

Marlene Held
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Marlene Held

My husband has Lyme disease and they say he has Parkinson’s but the meds really aren’t doing anything and I’m watching the man I love disappear. I would really like to know about this test/scan. He did 1 month oral and 1 month pic line and then he was put on Parkinson’s meds. He did have one brain scan that showed white matter. We are in northern Wisconsin.

Karen
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Karen

I ended up it the hospital for acute angle closure glaucoma due to starting Lexapro. I had fluid on my brain. Many procedures have been done over the last 2 years. Was tested for Lyme which came back saying I had had Lyme for a year plus. Took Doxycycline for 8 months. Joints got better, now everything is worse. The shaking, tremors, stress, anxiety…… Taking anxiety meds but it still doesn’t stop these symptoms. Trying easy yoga. Cannot stand on one foot or the other with out holding on to something. Many other issues but is this part of the… Read more »

Julia
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My mother was diagnosed with Lyme in September of 2015 and then Parkinson’s in November of the same year. No telling when exposure to the Lyme happened but I’m concerned that long-term Lyme symptoms may be complicating her Parkinson’s symptoms – or maybe causing them? Having a hard time getting her PCP, neurologist and the infectious disease department at the hospital where she is treated to discuss this with me. Her response to the Parkinson’s meds have been marginal and her symptoms are progressing. I would like to get her retested for a Borrelia infection to rule out interference by… Read more »

Carol
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Good luck, many doctors still deny Lyme. My sisters-in-law was diagnosed with Parkinson’s at 58 because her mother had Parkinson’s . 19 years later and many clinical trials with Johns Hopkins, and non typical symptoms her daughter sent her urine for Lyme DNA and it was positive. Too much damage, not much better with IV treatment.

Chuck
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Chuck

I have had LD for about 15 years. I have had four recurrences resulting in a new disease 1. Fibromyalgia 2nd= Asthma 3rd= Lupus 4th= Parkinson’s. None of these are genetically in my family. What test are any of you getting that shows positivity? When I mention Lyme to any Dr. but my Lyme specialist I get “That look”.
So far, the medicine I am taking- the cure is worse than the disease.
I am starting to realize that Lyme always wins.

Judith M Bilbrey
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My husband has Lymes and it is affecting his balance. It also attacks his joint etc. I was wondering what to do for him. I have tried different supplimentes but they don’t seem to be helping. I am afraid that the Lymes will cause brain damage. The last three weeks he is getting more unbalance that the last year. He has to have a cane or me to balance him. At times as a minister he is unable to make sense of what he reads. Can this lead to Parkinson’s???
Help please

Fiona
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Fiona

Is it possible to get some more information regarding the treatment of the second patient? I fit the profile and am trying to get my neurologist and Lyme specialist to have a dialogue as I would like to try this treatment approach. I was very excited by this article as I bave been trying to find a connection between Lyme disease and an irregular Dat scan.

Many thanks

Hartley
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Hartley

I’ve been taking Doxycycline in “pulse therapy ” mode (three days on, four days off) for a couple of years now. Still two active Lyme bands on blood tests. It this going to be the drill for the rest of my life, or is there hope a more permanent solution will be found some day?

Elaine
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Elaine

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.

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

Jean
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Where do you practice? and what company did the Lyme test? Igenex ( spelling?) may produce m ore cases of Lyme

Vuokko Virta
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Vuokko Virta

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!

Marta Sanimill
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Marta Sanimill

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.

Sally Dant
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Sally Dant

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
Guest

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.