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Lyme
disease presenting as Tourette's syndrome
pdf Michael
Riedel, Andreas Straube, Markus J. Schwarz, Betina Wilske, Norbert Müller Lyme
borreliosis is often misdiagnosed, both in adults and children.1
Central-nervous-system manifestations of Lyme disease include neurological and
psychiatric symptoms.2 Although abnormal movements
have been
observed in Lyme disease,3 a Tourette's syndrome has not been
reported. A boy at the age of 4 years developed a simple motor tic (blinking) that resolved within a year without treatment. At the age of 9 years, he developed multiple orofacial tics including shaking of the head, and several weeks later a vocal tic occurred. The tics became exacerbated under stress, as typically seen in Tourette's syndrome. Social disabilities such as loss of impulse control, social withdrawal, and worsened performance at school followed. He came to hospital 11 months after onset of symptoms. Serum IgM
antibody titres against Borrelia
burgdorferi measured by ELISA were not increased, although IgG antibody
titres (ELISA) were increased at 58 U/mL (normal ≤ 10 U/mL) and
100
U/mL at another examination 2 weeks later. Immunofluorescence absorption test (IFT)
was also increased (1:128 [normal: ≤ 1:16]). IgG immunoblot4
was positive. All results indicated an infection with B burgdorferi. Examination of the cerebral spinal fluid showed a
slight lymphocytic pleocytosis. (16 cells per µL), which suggested an
inflammatory reaction. The CSF:serum igG ratio for IgG antibodies was 2∙0,
indicating intrathecal production of B
burgdorferi-specific IgG antibodies, as occurs in neuroborreliosis.4 The boy was treated with intravenous ceftriaxone 2 g daily for 14 days. The tics improved after the sixth dose, and after the tenth dose the tics resolved completely. His social skills returned to normal. Follow-up examinations showed no recurrence of tics or other neurological or psychiatric disorder. Serum IgG antibody titres and IFT tests against B burgdorferi were 11 U/mL and 1:32 after 1 year. Rapid efficacy of antibiotic treatment followed by a decrease in Borrelia-specific antibody titres suggests that the multiple motor and vocal tics were at least partially caused by the tertiary stage of borreliosis.5 Persistence of the tics and increasing severity of the social disabilities over several months suggest that the first signs of a Tourette-like syndrome 11 months previously were an expression of an early Lyme infection. Infection with B burgdorferi should be considered in cases of Tourette's syndrome in endemic areas. Shapiro ED, Selzter EG. Lyme disease in children. Semin Neurol 1997; 17: 39-44. Kaplan
RF, Jones-Woodward L. Lyme encephalopathy: a neuropsychological
perspective. Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF. Psychiatric
manifestations of Wilske
B, Fingerle V, Herzer P, et al. Recombinant immunoblot in the serodiagnosis of Pfister HW, Wilske B, Weber K.
Lyme borreliosis: basic science and clinical aspects. Psychiatric Hospital (N. Müller), Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, 81377 Munich, Germany and Max-von-Pettenkofer Institute, Munich © 1998 The Lancet ∙ 42 Bedford Square London WC1B 3SL UK Publication by courtesy of Prof. Dr. Norbert Müller,
Munich, Germany . |
