For thos of you with tics

[lss]

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.

Semin Neurol 1997; 17: 31-37

 

Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF. Psychiatric manifestations of Lyme Borreliosis.

J Clin Psychiatry 1997; 54: 263-68.

 

Wilske B, Fingerle V, Herzer P, et al. Recombinant immunoblot in the serodiagnosis of Lyme Borreliosis.

Med Mikrobiol Immunol 1993; 182: 255-70.

 

Pfister HW, Wilske B, Weber K. Lyme borreliosis: basic science and clinical aspects.

Lancet 1994; 363: 1013-16.

 

 

 

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

 

 

I am not saying that everyone with tics has lyme, but it would be worth looking into.

 

Linda

[chodnett]

WOW! Now I really know we must test for LYME. She had a rash for sure that was a possible fifth disese before she presented with a seizure. that was the begining of this whole train we have been on. Her personality changed after that but tics did not present until almost 2 years to the date.

Question:

So if testing for LYME does western blot cover this? What IGENIX test would be specific to this?

[P_Mom]

This thread would also be very helpful on the TS forum. Please also post there, that would be great!

[NancyD]

If your child is on abx do the IGX Basic Lyme Panel ($260). Also suggest doing CD3/CD57 from Labcorp (IGX also does it).

 

WOW! Now I really know we must test for LYME. She had a rash for sure that was a possible fifth disese before she presented with a seizure. that was the begining of this whole train we have been on. Her personality changed after that but tics did not present until almost 2 years to the date.

Question:

So if testing for LYME does western blot cover this? What IGENIX test would be specific to this?

[LNN]

This thread would also be very helpful on the TS forum. Please also post there, that would be great!

 

Good idea. I think sometimes when I learn about things, I immediately think to share it with those I know on the forums I visit but forget that there are others on Latitudes that could also benefit.

 

LSS- thanks for sharing. What really caught my eye was that they mention a transient eye tic so many years prior and yet the way I read it, they don't suggest that lyme was the cause all the way back then.

 

Some of us have talked before about how our kids showed "signs" in toddlerhood but nothing full blown enough to pursue at the time (particularly eye blinking). I've tried to create a timeline in my head for what happened to my son. He had the eye blinking for a few days as a toddler. Episodic behaviors we didn't understand but were like a light switch - they were so "sudden". Then he had a tick bite. A few months later, strep and full blown Pandas. So did he have lyme all along? Not if I go back to the eye blinking and odd episodes (not obviously linked to infections) in toddlerhood. Did he not have Pandas? I don't think that's right either. He was so clearly effected by strep episodes. I don't know that I'll ever know.

 

I can only speculate that he had an immune system that started mis-firing early on. It learned bad behaviors. Then subsequent infections became all the harder for his system to handle correctly or effectively. By the time we were on the crazy road to "controversial" treatments and labels, it was all muddy. Maybe I'm reading too much into this article, but that's what I took away from this boy's experience too. He may have gotten a disease (in his case, lyme) that was a tipping point, but there were earlier things that may have pre-disposed him to manifest the disease in tic form, due to early life things the immune system incorrectly learned.

 

My younger daughter is now showing symptoms of something that are way too familiar. She's been on our radar for 2 years, but we can't find any smoking gun. My fear is that the next biggie infection - whether it be a tick bite, a mosquito bite, strep, myco, whatever - will be her tipping point. And yet, how do you treat her before that happens, when you don't know what exactly is wrong. You just see storm clouds, but no rain. Sorry - a little off topic.

[kimballot]

My younger daughter is now showing symptoms of something that are way too familiar. She's been on our radar for 2 years, but we can't find any smoking gun. My fear is that the next biggie infection - whether it be a tick bite, a mosquito bite, strep, myco, whatever - will be her tipping point. And yet, how do you treat her before that happens, when you don't know what exactly is wrong. You just see storm clouds, but no rain. Sorry - a little off topic.

 

 

Yes - I see signs in my other child as well. I a keeping a close eye on her immune system - taking her to immunologist for full work up. Considering Cunningham test too - as baseline - Call me crazy - I don't care. I don't want to hit the tipping point.