title: Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.
abstract: BACKGROUND
  Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB.
  
  
  METHODS
  Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients.
  
  
  RESULTS
  Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children.
  
  
  CONCLUSIONS
  LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.
authors: Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.
authors: M H
authors: MH
authors: Correll
authors: Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.
authors: N
authors: N
authors: Datta
authors: Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors: H S S
authors: HS
authors: Arvidsson
authors: Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors: H A
authors: HA
authors: Melsom
authors: Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors: A K
authors: AK
authors: Thielberg
authors: Department of Pediatrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors: M
authors: M
authors: Bjerager
authors: Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors: M C
authors: MC
authors: Brodsky
authors: Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.
authors: J P
authors: JP
authors: Saunte
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000907:Antibodies, Bacterial / Q000276:immunology*; D025065:Borrelia burgdorferi / Q000276:immunology* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D015818:Eye Infections, Bacterial / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D020852:Lyme Neuroborreliosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D015835:Ocular Motility Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial
keywords: Child health (paediatrics); Infection; Muscles; Pupil