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:
- Pische G, Koob M, Wirth T et al. Subacute parkinsonism as a complication of Lyme disease. J Neurol, (2017).
- 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).
Julia
02/27/2018 (5:23 am)
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 the Lyme / make sure we are pursuing the correct treatment. Tips on how to get the doctors to take this seriously?
Dr. Daniel Cameron
02/27/2018 (8:00 pm)
The tick borne tests are not as reliable as we would like. We often have to use clinical judgment. Parkinson’s disease relies in part on clinical judgement. It is always possible to have both conditions as they are both common.
Carol
12/23/2018 (12:20 am)
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.
Dr. Daniel Cameron
12/23/2018 (1:05 am)
I am waiting on more data on the reliability of the urine DNA test. I have seen patients in my practice who have both parkinsonism and Lyme disease as they are bot common illnesses. There are co-infections in a tick that do not respond to IV.
Chuck
02/24/2018 (2:26 pm)
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.
Dr. Daniel Cameron
02/25/2018 (8:52 pm)
The tests for tick borne illnesses can be disappointing. Treatment can be difficult. Treating for other conditions may fail. Keep working on getting better.
Judith M Bilbrey
11/30/2017 (6:49 pm)
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
Dr. Daniel Cameron
12/02/2017 (1:47 am)
I am sorry to hear your husband is ill. It can be difficult to find the cause of cognitive issues and balance problems. The blog reminds us to add subacute parkinsonism to the list of potential causes. There is always the possibility he could suffer from both tick borne conditions and Parkinsonisms.
Fiona
06/21/2017 (7:12 pm)
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
Dr. Daniel Cameron
06/21/2017 (11:39 pm)
You would have to write to the author of the article reviewed by All Things Lyme for more information.
Hartley
05/28/2017 (6:52 pm)
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?
Dr. Daniel Cameron
05/29/2017 (7:24 pm)
I am not a fan of pulse therapy. You may want to look at other approaches.