Brain, Vol 120, Issue 11 1975-1987, Copyright © 1997 by Oxford University Press
PJ Grattan-Smith, JG Morris, HM Johnston, C Yiannikas, R Malik, R Russell and RA Ouvrier
The clinical and neurophysiological findings in six Australian children
with generalized tick paralysis are described. Paralysis is usually caused
by the mature female of the species Ixodes holocyclus. It most frequently
occurs in the spring and summer months but can be seen at any time of year.
Children aged 1-5 years are most commonly affected. The tick is usually
found in the scalp, often behind the ear. The typical presentation is a
prodrome followed by the development of an unsteady gait, and then
ascending, symmetrical, flaccid paralysis. Early cranial nerve involvement
is a feature, particularly the presence of both internal and external
ophthalmoplegia. In contrast to the experience with North American ticks,
worsening of paralysis in the 24- 48 h following tick removal is common and
the child must be carefully observed over this period. Death from
respiratory failure was relatively common in the first half of the century
and tick paralysis remains a potentially fatal condition. Respiratory
support may be required for > 1 week but full recovery occurs. This is
slow with several weeks passing before the child can walk unaided.
Anti-toxin has a role in the treatment of seriously ill children but there
is a high incidence of acute allergy and serum sickness. Neurophysiological
studies reveal low-amplitude compound muscle action potentials with normal
motor conduction velocities, normal sensory studies and normal response to
repetitive stimulation. The biochemical structure of the toxin of I.
holocyclus has not been fully characterized but there are many clinical,
neurophysiological and experimental similarities to botulinum toxin.
ARTICLES
Clinical and neurophysiological features of tick paralysis
Department of Paediatrics, Westmead Hospital, Sydney, Australia.
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