ABSTRACT
Neuralgic amyotrophy (NA) is a neurologic syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discuss the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation, and overall prognosis of NA. LEVEL OF EVIDENCE: V.
Subject(s)
Brachial Plexus Neuritis/diagnosis , Inpatients , Lyme Disease/complications , Muscle Strength/physiology , Muscular Atrophy/diagnosis , Occupational Therapy/methods , Physical Therapy Modalities , Aged , Brachial Plexus Neuritis/complications , Brachial Plexus Neuritis/rehabilitation , Humans , Lyme Disease/diagnosis , Lyme Disease/rehabilitation , Male , Muscular Atrophy/etiology , Muscular Atrophy/rehabilitation , Recovery of FunctionABSTRACT
BACKGROUND AND PURPOSE: Lyme disease is well documented in the literature; however, specific physical therapy interventions for the pediatric population with residual effects of Lyme disease have not been addressed. The purposes of this retrospective case report are: (1) to present an example of a therapeutic intervention for a pediatric patient in the late stages of Lyme disease with related musculoskeletal dysfunction and severely impaired quality of life, (2) to report the patient's functional outcomes from treatment, and (3) to discuss implications for treatment of patients with musculoskeletal dysfunction in the late stages of Lyme disease. CASE DESCRIPTION: The patient was a 14-year old girl who had contracted Lyme disease 1 year prior to initiation of physical therapy. She was unable to participate with her peers in school, church, and sporting events due to significant impairments in strength (force-generating capacity), endurance, and gait; fatigue; pain; and total body tremor. Therapeutic exercise and gait training were used for treatment. The patient actively participated in managing her care by providing feedback during interventions and setting goals. OUTCOMES: After 18 weeks of treatment, the patient achieved 96.7% of her predicted distance on the Six-Minute Walk Test with normal gait mechanics and returned to playing high school sports. She had a manual muscle test grade of 4/5 or greater in major extremity muscle groups. She returned to school and church participation with minimal total body tremor when fatigued and daily pain rated 0 to 3/10. DISCUSSION: Therapeutic exercise and gait training may facilitate return to function in an adolescent patient with late effects of Lyme disease. Further investigation is advised to establish treatment effects in a broader population.
Subject(s)
Exercise Therapy/methods , Lyme Disease/physiopathology , Lyme Disease/rehabilitation , Adolescent , Biomechanical Phenomena , Female , Gait , Humans , Pain Measurement , Physical Therapy ModalitiesABSTRACT
The studies made in 96 patients suffering from chronic ixode tick borreliosis with a prevalent joint lesion justified two-stage treatment with physiotherapy at the second stage. The proposed therapy is well tolerated, produced a good improvement in 82.4% patients, the response persisting for 8.8 +/- 0.2 months vs 5.6 +/- 1.0 months in the control group on pharmacotherapy alone.
Subject(s)
Joints/pathology , Lyme Disease/rehabilitation , Tick-Borne Diseases/rehabilitation , Adult , Balneology , Dietary Supplements , Female , Humans , Lyme Disease/pathology , Lyme Disease/therapy , Male , Massage , Middle Aged , Tick-Borne Diseases/pathology , Tick-Borne Diseases/therapyABSTRACT
Antibiotic treatment--usually stage-dependent in terms of the active agent, duration and form of application--is the central pillar in the management of Lyme disease. In the late stages of borreliosis, symptoms may persist despite extensive and repeated antibiotic treatment. In this phase, borreliosis-typical neuropathy and neuralgia, chronic fatigue and neuropsychological deficits predominate. Irrespective of whether renewed antibiotic treatment is indicated or not, symptomatic treatment must be continued.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antidepressive Agents/therapeutic use , Depressive Disorder/rehabilitation , Fatigue Syndrome, Chronic/rehabilitation , Lyme Disease/rehabilitation , Lyme Neuroborreliosis/rehabilitation , Physical Therapy Modalities , Combined Modality Therapy , Depressive Disorder/etiology , Fatigue Syndrome, Chronic/etiology , Humans , Lyme Disease/diagnosis , Lyme Neuroborreliosis/diagnosis , PrognosisSubject(s)
Lyme Disease/diagnosis , Ambulatory Care , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Doxycycline/therapeutic use , Follow-Up Studies , Humans , Lyme Disease/complications , Lyme Disease/drug therapy , Lyme Disease/rehabilitation , Penicillins/therapeutic use , Time FactorsABSTRACT
La enfermedad de Lyme es una zoonosis producida por la espiroqueta Borrelia burgdoferi y transmitida por el ácaro Ixodes dammini, denominado comúnmente "garrapata". Se manifiesta clínicamente en dos fases caracterizadas así: Fase temprana, comprende dos estadíos, el primero, presenta eritema migrante, cefalea, fiebre, rigidez nucal, fatiga y mialgias; el segundo, meningitis, neuritis craneal, meningoencefalitis, bloqueo auriculoventricular de primer o tercer grado y ocasionalmente miocarditis o pericarditis. Fase tardía presenta poliartritis migratoria y algunos trastornos neurológicos. Fisiopatológicamente, se cree que la enfermedad se debe a depósito de complejos inmunes con activación del complemento y a la liberación de interleukina-1 por los macrófagos. El diagnóstico se basa en la clínica y epidemiología; se confirma usando métodos directos como el cultivo y análisis de biopsias, o métodos indirectos como la inmunofluorescencia indirecta y el ELISA. Se trata la infección con penicilina, eritromicina o cefalosporina
