- Neuropsychiatric Presentations Lyme Disease
Neuropsychiatric Presentations Lyme Disease
Of Lyme disease
Both adults and children can suffer from a broad range of neuropsychiatric manifestations due to tick-borne diseases. There’s particular concern, since studies have indicated that the Lyme bacterium, within weeks of infection, can disseminate to the Central Nervous System (CNS) where it can remain dormant for months, even years before producing symptoms.
A study conducted in 2004 at Columbia University’s Lyme and Tick-borne Disease Research Center found children with Lyme disease had substantial cognitive and psychiatric disturbances. And, cognitive impairments were still present after controlling for anxiety, depression and fatigue.
Neuropsychiatric symptoms may be the first symptom recognized or can surface months or years later. One study found Lyme encephalopathy in children presented with “memory impairment, irritability and somnolence” months to years after the initial classical presentation of Lyme disease. Another study found 4% of children with Lyme disease developed encephalopathy more than 10 years after onset of the disease.
Neuropsychiatric symptoms improved with antibiotics in: 1) a 12-year-old boy with Lyme arthritis, depression, and anorexia,  and 2) a 21-year-old with progressive confusion, agitation, disorientation, inappropriate laughter, and violent outbursts with spirochetes in on a temporal lobe biopsy,  and 3) an 18-year-old college freshman with severe and sustained anxiety, depersonalization, and panic attacks associated with insomnia and appetite loss.  Lyme disease psychiatric manifestations such as behavioral changes and memory deficits may have its greatest impact on school performance and quality of life. Intellectual functioning may be normal but auditory or visual sequential processing pathology have been reported. [5,6,7]
In a well-designed controlled study investigating cognitive impairment in children having
already received antibiotic therapy (previous medication type, dose, and treatment duration not reported), a significant number continued to experience problems. 
Neurocognitive testing revealed frequent and severe headaches (100%), brain fog
(88%), short-term memory loss (94%), word-finding problems (82%), distractibility (82%), schoolwork deterioration (94%), irritability/depression (94%), insomnia (82%), and sensitivity to sound (58%) and/or light (74%).
Another study reported children with Lyme disease exhibited oppositional behavior, anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD).  A report by Riedel et al. described a child with Lyme disease presenting with Tourette’s syndrome, a neurologic tic disorder also seen in PANDAS, which resolved with antibiotic treatment. 
While focus in this section has been on the neuropsychiatric impact in children and adolescents, adults can suffer significantly as well. Studies by Fallon et. al. have found that Lyme disease in adults has been associated with a range of psychiatric ailments including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder.
Meanwhile, the study described 11 out of 13 Lyme encephalopathy patients (85%) showing a clear improvement in their neuropsychiatric symptoms within 1–3 months after a four-week course of IV ceftriaxone.
References – Neuropsychiatric Presentations
- Bloom BJ, Wyckoff PM, Meissner HC, Steere AC. Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatr Infect Dis J, 17(3), 189-196 (1998).
- Szer IS, Taylor E, Steere AC. The long-term course of Lyme arthritis in children. N Engl J Med, 325(3), 159-163 (1991).
- Mink J, Kurlan R. Acute postinfectious movement and psychiatric disorders in children and adolescents. J Child Neurol. 2011;26(2): 214–217.
- Perry CB. Erythema marginatum (rheumaticum). Arch Dis Child. 1937;12(70):233–238.
- Bloom BJ, Wyckoff PM, Meissner HC, Steere AC. Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatr Infect Dis J. 1998;17(3):189–196.
- Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693–703, viii.
- McAuliffe P, Brassard MR, Fallon B. Memory and executive functions in adolescents with posttreatment Lyme disease. Appl Neuropsychol. 2008;15(3):208–219.
- Tager FA, Fallon BA, Keilp J, Rissenberg M, Jones CR, Liebowitz MR. A controlled study of cognitive deficits in children with chronic Lyme disease. J Neuropsychiatry Clin Neurosci. 2001;13(4):500–507.
- Riedel M, Straube A, Schwarz MJ, Wilske B, Muller N. Lyme disease presenting as Tourette’s syndrome. Lancet. 1998;351(9100):418–419.
The incidence of Lyme disease in children is growing despite efforts for greater awareness and prevention. According to the CDC, the highest infection rates occur in children, ages 5 to 9. Overall, the disease is most common among boys, ages 5-19. Each year, at least 300,000 people in the U.S. are diagnosed with Lyme disease, 25% of those are children, ages 5 to 9. learn more →
If a woman is bitten by a deer tick or contracts Lyme disease while pregnant, it’s important that she immediately alert her treating physician. There have been poor outcomes described for newborns whose mothers contracted Lyme disease during pregnancy. learn more →
Lyme disease can cause persistent symptoms that reflect multi-organ involvement, with episodes of active disease and periods of remission. The same capability, of microorganisms to cause and exacerbate neuropsychiatric pathology, is also seen in Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). learn more →