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).
Larry Fredette
11/10/2020 (9:52 am)
I tested positive for 3 Lyme bands.
I have severe tremor of left, and now
on right side. I was treated with oral
and IV anti-biotics. No tremor improvement after 6 months.
What is the recommended lyme tremor treatment protocol ?
Thanks
Dr. Daniel Cameron
11/10/2020 (6:59 pm)
I have patients where is unclear if Lyme disease and tick-borne illnesses are present. I arrange for consultations with other doctors to look for other illnesses. I have to comb over some patients to see if their are any treatment options.
Robin Dulaney
11/10/2020 (3:15 am)
Please Help! About 4 years ago (2016) I started noticing cognitive decline in my 51 year old husband. In 2018, his general practitioner did some blood tests which included “Lyme Ab IgG” and “Lyme Ab IgM” which both came back Negative. They also tested for Methylmalonic Acid, Vitamin B1, RPR, Ammonia, Lead, Arsenic, Mercury & Cadmium, which all came back normal. After much research, in February of 2019 @ 53 years old he was diagnosed via a DatScan with this “IMPRESSION: Decreased radiotracer binding in the basal ganglia consistent with Parkinson’s disease and/or dementia with Lewy body disease. ” 3 Neurologists have diagnosed my husband with Lewy Body Dementia, since, Cognitive Decline was his first symptom. He has very little movement disorders (some twitching, slow movement, scuffs feet walking, doesn’t swing arms walking, drooped eyelids, drooling, small handwriting, difficulty cutting meat, etc.). John’s Hopkins Neurologist diagnosed him with Atypical Parkinsonian Syndrome. In August of 2019 a PET Brain Scan indicated “Symmetric hypometabolism in bilateral frontal, temporal and parietal lobes”. Recently I was looking up “Hypometabolism” and found ““Seven of the patients with temporal lobe hypometabolism had diffuse cortical hypometabolism that included the frontal and parietal lobes. LYME DISEASE appears to have two primary patterns of brain involvement on FDG PET scans, specific temporal lobe hypometabolism or a diffuse cortical hypometabolism.”. This got me wondering about Lyme disease, even though he originally tested Negative in 2018, WHICH IS WHY I AM MESSAGING YOU. With all of this information, do you recommend another Lyme Disease blood test…and if so….please reply with the specific blood test for Lyme Disease (or any other test….based on my information). Please reply via Email….and THANKS (so much) IN ADVANCE FOR YOUR RESPONSE! Robin – Severna Park, MD
Dr. Daniel Cameron
11/10/2020 (7:41 am)
The Lyme disease and tick borne illnesses are not as reliable as I would like. I typically look a second time for Lyme disease.
Laurie
10/08/2020 (2:45 pm)
I was diagnosed with spasmodic dysphonia and vocal tremor due to an issue with the basal ganglia . I have a history of Lyme disease several years ago. Unfortunately I am allergic to cephalosporins are there other options?
Dr. Daniel Cameron
10/08/2020 (2:56 pm)
There are a number of other options beyond cephalosporins. Call my office at 914 666 4665 if you have any questions.
Emily Frangipane
09/29/2020 (3:49 pm)
Hello-
Im 49 year old woman. Im otherwise very healthy and extremely physically active. I am a trained dancer. 3 years ago I began noticing tension in my right arm and hand. It was affecting my coordination and movement of my right arm. I would FEEL like my arm was doing a movement with 100% energy and length but videos showed otherwise. I have complete control over relaxing it. brushing my teeth and writing have been a chore and the tension is great. Again, I can relax it easily. 3 Neurologists have said my exam is totally normal and I dont present with typical Parkinsons but a DAT scan showed low dopamine levels and my Neuro at Yale said she thinks its Parkinsons or a rare brain disease. However they are stumped. Could it be co-infections/Lyme?
Thank you so much
Dr. Daniel Cameron
09/29/2020 (6:40 pm)
It can be difficult to rule Lyme disease.
Cory
06/15/2020 (6:25 pm)
Hi Dr. Cameron,
I recently had a fall, I’m 33 years old male. I hit my head and rolled my foot. I live in the Northwest Suburbs of Chicago. I went to the ER because I wasn’t able to put pressure on it and thought I had broken it again. They did a CT on my head, x-ray on foot and and back. Things came out fine except for my CT scan. The Dr. there came in and asked if I had ever had a stroke and I said no, she said what I have on my brain isn’t related to the fall and it’s old not new. I’m completely illiterate on matters concerning the areas of the brain. I also have symptoms concerning movement and somewhat uncoordinated; this is what the report says: Gray-white differentiation is grossly preserved. 9 mm x 6 mm focal hypodensity in the left basal ganglia region, probably dilated perivascular space in a patient this age, less likely chronic lacunar infarct. I went untreated with lyme and bartonella for 19 years, my first symptom that I developed was hand tremors, followed by sudden development of high BP, nevus of ota in my right eye, arrhythmia with tachycardia, panic attack/anxiety/agoraphobia, weird stretch marks that are all over my body, profuse sweating, and a multitude of other symptoms. I was treated Septemeber 2019 with Azithromycin for 1 month for bartonella(I beleive), and then a PICC line put in for 28 days of rocephin. I am not sure if I was correctly treated for bartonella or lyme. Is this normal for people with lyme to have that in there brain? Was treatment sufficient? The doctor I see in Elgin told me I have to wait a year to 18 months to see if things get better. I have an MRI scheduled next week. I appreciate your time, if you’d like to send me and email you should have access to see it otherwise I’ll check here.
Dr. Daniel Cameron
06/15/2020 (6:35 pm)
White spots can occur in many illnesses. I have patients in my practice with sweats that may suffer from Babesia. I find personalized treatment protocols helpful for patients. I also refer my patients to specialists to rule out other illnesses. Give my office a call at 914 666 4666 if you have any questions.