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).
Marcy N
04/14/2024 (7:54 am)
My husband is 52. He began having movement & brain fog issues after COVID two years ago; particularly having issues on his left side & shuffling.
His DAT was completed two days ago. He is now diagnosed with “Fairly advanced Parkinsonism”. We live in Arkansas. Myself and our oldest daughter have beth been treated for lyme from 2015-2020. My husband has refused to get tested for 10 years now. And his DAT scan reads: “Exam is abnormal. There is very little uptake seen on the right and what is seen in the right basal ganglia is confined to the caudate nucleus. There is activity seen on the left but it is confined to the basal ganglia and does not extend into the striata or putamen.”
My question: Would finding a local doctor to prescribe the antibiotics still be worth a shot? I do not know what else we could afford at this time. He is our bread winner. Maybe a tele-appointment for advice.
(Incidentally our oldest daughter has lyme borreliosis (AE) with epilepsy & autism and our other daughter has T1D.)
Dr. Daniel Cameron
04/14/2024 (6:36 pm)
I have had patients who have had a tick borne infection and Parkinson’s disease. I rely on the neurologist to manage their Parkinsonism. I found treatment for their tick borne illness helped their other symptoms. Call my office 914 666 4665 with your question.
J. Ackerman
08/02/2022 (10:16 pm)
My brother has Parkinson’s. We grew up in a highly populated tick area. After an accident, having run through the mill of doctors and psychiatrists, having had Physical therapy for fifteen years, three doctors, during the same year, told me, his sister, to go out of the system and see a Lyme disease doctor. Over a two year period, and I can’t even begin to tell you how many antibiotics I’d been on, I got to the point that I could get off the sofa. I spoke with the Mayo, but they do not really back Chronic Lyme disease. Now, my brother is sick. His information is below. Are the statements included about Lyme disease correct or should he look at the possibility that Lyme disease has caused his problems.
This is my brother’s note….
A year or so ago I was tested for Lymes and it came back clean.
I had a daT brain scan which showed both dopamine areas of my brain were low. That is a positive hit to identify Parkinson’s. This is a rare test. Most folks are not successful in trying to convince their doctors that such a test is useful to confirm Parkinson’s because they base their findings on numerous visual/physcial tests.
Not only that but the medication works for me. It stops tremors. They say Lymes does not cause depletion of dopamine or cause most of the motor skills that Parkinson’s does. I also read that Parkinson’s medication does nothing to mask the symptoms of Lymes. So…in my case the meds are working, which proves Parkinson’s. My only hope is to be one of the very few lucky enough to get DBS (Deep Brain Stimulation) which will cancel most of the Parkinson’s effects.
Dr. Daniel Cameron
08/03/2022 (11:54 am)
Lyme and Parkinson’s are both common. Some of my patients have had both. Ticks don’t care who they get a meal from. I have not tested my Lyme disease patients without Parkinson’s disease with a daT scan. I also have not treated my Lyme disease patients with Parkinson’s medication. I wish you well.