Borrelioosia ei osata useinkaan diagnosoida oikein. Seuraavan tapausselostuksen pojalla ilmeni 4-vuotiaana nykimistä, "elohiiri", joka hävisi ilman hoitoa. Vuosien kuluttua (9-vuotiaana) hänellä alkoi ilmetä nykimistä kasvoissa, pään nytkähtelyä, sosiaalista vetäytymistä, koulumenestys heikkeni jne. Pojalla todettiin borrelioosi joka aiheutti Touretten kaltaisen oireiston. Oireet hävisivät antibioottihoidolla. Touretten syndrooman yhteydessä tulisi selvittää borrelioosin mahdollisuus.
The Lancet Vol. 351-February 7, 1998
Lyme disease presenting as Tourette's syndrome
Michael Riedel, Andreas Straube, Markus J Schwartz, 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 resoved within a year without treatment. At the age of 9 years, he developed
* multiple orafacial 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 withdrawl, worsened performance at school followed.
He came to hospital at 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 \< U/ml) and 100 U/mL at another examination 2 weeks later.
* Immunoflourescence absorption test (IFT) was also increased (1:28 [normal \<1:16]).
* IgG immunoblot (4) was positive.
All results indicated an infection with B burgdorferi.
Examination of cerebral fluid
* showed a slight lymphocytic pleocytosis (16 cells per uL) (5) which suggested an inflammatory reaction.
* The CSF: serum IgG ratio for IgG antibodies was 2.0, indicating intraethecal 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 reccurence of tics or other neurological or psychiatric disorder.
* Serum IgG antibody titre tests and IFT tests against B burgdorferi were 11 U/mlL 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.
1. Shapiro ED, Selzter EG, Lyme disease in children. Semin Neurol 1997;17:39-44.
2. Kaplan RF, Jones-Woodward L,. Lyme encephalopathy; a neuropsychological perspective. Semin Neurol 1997;17:31-37
3. Fallon BA, Nields JA, Parsons B, Liebowitz MR, Klein DF, Psychiatric manifestations of Lyme Borreliosis. J Clin Psychiatry 1997;54:263-68
4. Wilske B, Fingerle V, Herzer P, et al. Recombinant immunoblot in the serodiagnosis of Lyme borreliosis. Med Mikrobiol Immunol 1993; 182:255-70.
5. Pfister HW, Wilske B, Weber K., Lyme borreliosis: basic science and clinical aspects. Lancet 1994; 363:1031-16