Objective: To describe unusaul case of paroxysmal non-kinesigenic dyskinesia due to Lyme neuroborreliosis in a elderly female patient.

Background: Nervous system Lyme disease is common neurological condition that may present with unusual symptoms. Paroxysmal non-kinesigenic dyskinesias (PNKD) are a rare intermitent episodic involuntary movement disorders. PNKD are usually familial, but they can be sporadic or secondary to organic cause or pathology.

Method: we report a case of 54-years old female who presented with intermittent attacks of involuntary dystonic contractions of the right half of the face. Attacks usually lasted about 10 minutes and occurred up to 2 times a week for the past four years. The possibility that the patient may be manifesting a PNKD was considered, according to the DSM-5 criteria. As there is sufficient clinical suspicion, serological testing and detection of inflammatory changes in cerebrospinal fluid linked to Borrelia-specific intrathecal antibody synthesis was conducted

Results: The patient scored 30/40 on Abnormal Involuntary Movement Scale, and her score on the Naranjo Adverse Drug Reaction Probability scale was 8 ponts. Medical history indicated to Lyme neuroboreliosis, while clinical features was suggestive of PNKD. Further test results including positive serologies and cerebrospinal fluid antibodies for Borrelia, the diagnosis of Lyme neuroborreliosis was considered. Further examination revealed exposure to ticks and there was report on typical skin lesions. Appropriate antibiotic therapy with parenteral ceftriaxone resulted in complete recovery of motor symptoms and functional status

Conclusion: The emphasis is placed on the atypical onset and evolution, the difficulties establishing diagnosis. In elderly patient with non-specific long lasting PNKD, Lyme neuroborreliosis should be considered

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MDS Abstracts - https://www.mdsabstracts.org/abstract/paroxysmal-non-kinesigenic-dyskinesia-atypical-neurological-presentation-of-lyme-neuroborreliosis/