Tremor, seizures and psychosis as presenting symptoms in a patient with chronic Lyme neuroborreliosis (Lnb) [Tremor, epileptički napadaji i psihoza kao prezentiraju i simptomi u bolesnika s kroničnom Lyme neuroboreliozom]

Markeljević, Jasenka and Šarac, Helena and Radoš, Marko (2011) Tremor, seizures and psychosis as presenting symptoms in a patient with chronic Lyme neuroborreliosis (Lnb) [Tremor, epileptički napadaji i psihoza kao prezentiraju i simptomi u bolesnika s kroničnom Lyme neuroboreliozom]. Collegium Antropologicum, 35 (S. 1). pp. 313-318. ISSN 0350-6134

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Abstract

Lyme borreliosis is a multisystem disorder caused by Borrelia burgdorferi (Bb). Neurological symptoms such as lymphocytic meningoradiculoneuritis (Bannwart’s syndrome), cranial neuritis (II,III,IV,V,VI), encephalitis, transverse myelitis are found in about 10% of cases during the second phase of the disease. In the chronic stage, many months or years after the initial infection, other neurologic complications may occur, such as encephalomyelitis, epileptic crises, cognitive impairment, peripheral neuropathy and psychiatric disturbances such as depression, anxiety, panick attacks, catatonia, psychosis etc. Some patient continue to experience symptoms of fatigue, insomnia or psychiatric disorder in the post borrelia syndrome. We describe here a patient with a triad of unusual symptoms in chronic LNB including tremor, seizures and psychosis. Standardized medical interview, neurologic examination, neuroimaging, serum and CSF serology as well as EEG and EMNG evaluation were performed. The patient was treated with intravenous ceftriaxone and doxycycline and responded with rapid clinical and functional improvement. Newertheless, he suffered from multiple systemic and neurologic sequelas that influenced his daily activities in post treatment period. Emphasis is placed on the atypical onset and evolution, the difficulties encountered in formulating diagnosis, early treatment and the uncertainties concerning the sequelae after treatment. In patients with non-specific long lasting symptoms in the absence of overt clinical signs suggesting CNS involvement, routine treatment with i.v. ceftriaxone is not to be encouraged.

Abstract in Croatian

Lyme borelioza je ultisistemska bolest koju uzrokuje Borrelia burgdorferi (Bb). Neurološki simptomi limfocitni meningoradikukloneuritis (Bannwart’s syndrome), kranijski neuritis (II,III,IV,V,VI), encfalitis, transverzni mijelitis nalaze se u oko 10% bolesnika u drugom stadiju bolesti. U kroničnom stadiju, nekoliko mjeseci ili godina nakon inicijalne infekcije, mogu se javiti neurološke komplikacije i to encefalomijelitis, epileptičke krize, kognitivni deficiti, periferna neuropatija i psihijatrijski poremećaji kao depresija, anksioznost, panične atake, katatonija, psihoza i dr. Neki bolesnici imaju simptome opće slabosti, nesanicu ili psihičke simptome u tzv. »post borrelia sindromu«. Ovdje opisujemo bolesnika sa trijadom neobičnih simptoma kronične Lyme neuroborelioze uključujući tremor, epileptičke napadaje i psihozu. Evaluacija bolesnika obuhvatila je anamnezu, neurološki pregled, neuroimaging, serologiju seruma i cerebrospinalnog likvora, EEG i EMNG. Bolesnik je na terapiju ceftriaxonom i doxycyclinom intravenski reagirao brzim kliničkim i funkcionalnim oporavkom. Ipak, imao je multiple sistemske i neurološke komplikacije koje su utjecale na njegove svakodnevne aktivnosti u razdoblju nakon tretmana. Naglasak je stavljen na atipičan nastup i evoluciju simptoma bolesti, poteškoće u postavljnaju dijagnoze, rani tretman i neizvjesnost u pogledu komplikacija nakon tretmana. U bolesnika s nespecifičnim, dugotrajnim simptomima Lyme neuroborelioze, u odsutnosti drugih kliničkih znakova koji bi ukazivali na zahvaćenost CNS-a, rutinski tretman ceftriaxonom intravenski nema terapijskog efekta.

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