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.”


  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).

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

  • Deb G
    05/11/2020 (3:35 am)

    My husband has had the bullseye bite but was told it was nothing. They removed the tick as well. It was not long before he began to lose weight and seemed to weaken as well as have some balance issues and began shuffling. When he alerted his physicians to the weight loss they told him most people we see are obese. You are in great shape. Now we have concern of muscle wasting and he has been diagnosed with Parkinson’s but the Dr said he is too strong. Dat scan was abnormal thus the PD diagnosis. We have been told he can start on PD meds anytime he wants. Mentally he is declining and becoming weaker. We contour to research and found this Lymes disease dialogue associating the two. Neurologist wouldn’t even consider it and amid our questions turned to my husband and said ‘Do you have cancer?!’ We were shocked! His DO did further tests to rule out and we won’t go back to that Dr. so frustrating this journey we are on.

    • Dr. Daniel Cameron
      05/11/2020 (7:12 am)

      Thanks for sharing your husband’s story. We know the Dat scan is abnormal in Parkinson’s disease but so much for other diseases. I typically look for treatable illnesses in patients with a chronic illness. I find patients in my practice who suffer from a chronic illness and Lyme disease. Call the office at 914 666 4665 if you have any questions.

    • Deb
      07/03/2021 (2:44 pm)

      Did the doctors say he had STARI (southern tick associated rash illness) instead of Lyme? We are in a supposed Lyme free state and have had nearly identical path as you described. Now diagnosed with PD with DAT scan. All started not long after tick bite with bullseye rash.

      • Dr. Daniel Cameron
        07/03/2021 (3:50 pm)

        I am not convinced there is a Lyme free state. I suspect cases of Lyme disease are not reported or are dismissed as STARI.

  • Karla
    04/20/2020 (7:14 pm)

    I was diagnosed as Parkinson’s November 2019. I had a MRI which didn’t show any abnormalities. But my Neologist says symptoms show Parkinson’s . I just turned 60 and don’t want to waste a year taking Parkinson’s medication. I took it for a month and seen no improvement. Now he’s saying try a stronger dose. How do I get them to test for Lyme disease?

    • Dr. Daniel Cameron
      04/22/2020 (1:26 pm)

      Doctors are divided over whether to look at Lyme disease particularly if the tests are negative. You may have to also see a doctor with expertise in Lyme disease.

      • Karla
        05/10/2020 (9:56 am)

        My general physician did a blood test and results were negative. I’m still not convinced it’s Parkinson’s. I recently developed numbness and tingling in my ride side extremities. Which is not a sign of PD. I started taking the meds to see if it makes a difference. I’ll give it 2 months. Do you know of any doctor in southern Michigan whose expertise is Lymes? I would I find one?

        • Dr. Daniel Cameron
          05/10/2020 (11:20 am)

          You will find several websites that have directories to help you e.g., Global Lyme Alliance, Lyme Disease Association and ILADS. You can also call my office in New York at 914-666-4665 to find out if a teleconference would work.

        • Crystal Brum
          11/26/2021 (6:39 pm)

          My husband also was diagnosed with PD – neurologist and FAmily physician refuse to test for Lyme and when the subject was brought up they immediately dismissed me! His symptoms have been present since his mid 30s- he was on the levo-carb for over a year (4 pills daily) with NO difference except severe side effects! How do I force the doctor to test him for Lyme?!? It’s like they do t even want to treat you after you ask about Lyme! Very interested to see if you get any results or positive feedback! When I first met him 20 years ago – I dug what I thought was a tick out of his back- however by they it had been burrowed into the skin of his back for so long you couldn’t tell if it was a tick or not! But he still has a hole in his back where the sucker burrowed in there!! Told all of this to the neurologist and he basically yelled at me- this is PD you need to deal with it!!

          • Dr. Daniel Cameron
            11/27/2021 (8:00 am)

            I have had patients in my practice with Parkinson’s disease who are also ill with a tick-borne illness. Their tick-borne illness was overlooked.

    • Lindsay
      09/14/2021 (5:32 pm)

      Get them to sign off on an Igenex test out of network or buy one yourself. A dr that is Lyme literate has to be able to understand the info though. This test saved me after suffering for 15 yrs!

  • JR
    07/16/2019 (6:26 pm)

    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. JR

    • Dr. Daniel Cameron
      07/16/2019 (11:30 pm)

      I have patients that meet both Parkinson’s and Lyme criteria. I have not found the spinal tap all that helpful for my patients. I sometimes find an oral antibiotic that has overlooked.

  • Marlene Held
    06/28/2019 (1:01 am)

    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.

    • Dr. Daniel Cameron
      06/29/2019 (8:04 pm)

      Both Lyme disease and Parkinsonism are common illnesses. I reviewed the case as it examined whether the two illnesses could ever be related. It sounds as if the doctor considered a tick borne illness in your case. I do not know anyone in the area to help.

    • Michelle
      06/07/2023 (11:08 am)

      Marlene, I am from Central Wisconsin and have the same predicament.
      Did you find someone to help you?


    • Katie Card
      09/18/2023 (10:19 pm)

      There are some doctors and nurse practioners that are considered Lyme Literate that will help you treat Lyme and the co-infections which will not respond to the same antibiotics given for Lyme. Many people are co-infected. My Lyme literate Nurse Practitioner in northern WI says “everybody in WI has Lyme”. I got Lyme, Babesia, and Bartonella there visiting the Hayward area. My kids also have these diseases. They can mimic so many other diseases and most practioners are clueless!! Real world chronic Lyme, Babesia, Bart, etc is not taught in med school. Very complicated, but you can find your answers in researching these diseases!

      • Dr. Daniel Cameron
        09/19/2023 (7:29 am)

        BTW I have not concluded that everyone has Lyme disease. Everyone is at risk of Lyme disease. I am primarily concerned with individuals with Lyme disease who have been misdiagnosed or who are not aware they have Lyme disease.

    • Michelle
      11/21/2023 (10:39 am)

      Marlene, I am in Wisconsin and have a similar situation. Except it’s me who has the neurological problems.
      I know it’s been 4 years since your post, but I was wondering if you had an update.

  • Karen
    06/05/2018 (9:59 pm)

    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 Parkinson’s issue. Any other tests I can ask my Dr. for? Or do I just settle with it’s Lyme since neither seems to be curable?

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