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).
Robert
09/30/2021 (10:32 am)
I have a “Supertentorial lesion” or written a different way by a different neurologist said it’s “1 or 2 non specific bright white spots in the white matter right centrum semiovale”. I just got a DATSCAN and the the radiologist said it’s abnormal. But my neurologist said the uptake is good and nothing to worry about. Could my abnormal DATSCAN be a result of Lyme and or these lesions? Thank you
Dr. Daniel Cameron
09/30/2021 (11:28 am)
I wish I could be more helpful. I shared the case in a blog with the hope that it will encourage further research into the causes of an abnormal DATSCAN. I have not seen any additional research.
Jeannie Tyler
07/24/2021 (11:50 pm)
I was diagnosed with Lyme disease once about 20 years ago and again, with another active infection about 5 years ago. The first time it took me 7 trips to my Dr’s office to get tested then I was put on doxycycline for a month. The second time I was tested for Lyme disease the first time I went to the Dr but it took 2 weeks to get the results back and I wasn’t started on antibiotics until the results came back. That time they only put me on doxycycline for 2-3 weeks. I started having tremors in my lower left abdomen a few years ago and now they are all over me. I am also very painful all over every day and I have severe insomnia and I also have to push harder than normal when I urinate. I was told this by my urologist a few months ago after testing. Is it still possible that Lyme disease could be affecting my brain and that’s what could be causing my other symptoms I described above? I’m going to see my regular Dr next month and will be asking her to refer me to a neurologist but I would like to hear your opinion so I can have something to back me up when I see the neurologist as I know how some Dr’s react towards Lyme disease in the first place.
Dr. Daniel Cameron
07/25/2021 (7:51 am)
Neurologist typically focus on a broad range of illnesses. Some neurologists are reluctant to consider Lyme disease if the tests are negative, if 3 weeks of antibiotics have failed, or if their patient does not have a particular finding. I have seen individuals with unusual presentations thought to another illness.
Barbara Lea Mitzner
12/19/2021 (4:01 pm)
I had Parkinson’s
Like symptoms
Leg tremor. Moving internal tremors. Neurologist said probably PD. I started taking doxycycline from old Lyme diagnosis. All symptoms stopped. I believe this was Lymes recurring
S MARSHALL.
05/06/2021 (5:40 am)
I am a 62 yo female l discovered a bullseye type EM with central clearing, about 2 1/2 mos ago. I am testing negative (<.91) for IgG and IgM. I have the following symptoms: headaches, neck soreness, scalp tenderness, facial one side numbness and tingling, sore soles, swollen knee with painful joint, bad insomnia, tinnitus, neuropathy in extremities, difficulty multitasking and RLS. I also have involuntary body jerks sometimes as well. I have just finished 4 weeks of doxy and 2 weeks of Ceftin. The EM is still there and I basically feel bad. Any suggestions for what to do? Do you think that I have Lyme?? Thank you
Bob
11/30/2020 (9:13 pm)
I was diagnosed with unspecified Parkinsonism and my blood test revealed Lyme disease. I have tremors and a balance problem and a stumbling gait also
my hands are limp and the right side of my body is rigid. Any recommendations Doc?
Dr. Daniel Cameron
12/01/2020 (7:58 am)
I have had patients in my practice with both Lyme disease and an underlying illness.
Jennifer Young
11/21/2020 (10:53 am)
I had a basal ganglia infarct due most likely when I came off a 4 month round of antibiotic therapy, too soon, and was a month off of antibiotics. I had a three month headache that only subsided with steroid use. I had lost pituitary function due to Lyme beginning around 2006 after a tick bite. I was on hydrocortisone for panhypopituitarism-adrenal insufficiency-and developed a lung infection about Martin Luther King Day and went on to long acting steroids to treat the lung infection. I have a history of asthma beginning in childhood. Diagnosed by Elisa and Western blot at Stonybrook Labs as positive for Lyme 2010. Bit by a tick in 2006 in Portland, Oregon.