Tick paralysis results from inoculation of a toxin from tick salivary glands during
a blood meal. It is a relatively uncommon neuromuscular disease with a higher prevalence
among young girls, although older men who get exposed to ticks may also be affected.
It typically presents as an acute ascending paralysis occurring a few days after tick
attachment and may result in respiratory failure and death. Patients may report minor
sensory symptoms but constitutional signs are usually absent. Deep tendon reflexes
are usually hypoactive or absent and ophthalmoplegia and bulbar palsy can occur. Children
may be ataxic. Electromyographic studies usually show a variable reduction in the
amplitude of compound muscle action potentials but no abnormalities of repetitive
nerve stimulation studies. These appear to result from a failure of acetylcholine
release at the motor nerve terminal level. There may be subtle abnormalities of motor
nerve conduction velocity and sensory action potentials. Removal of the tick results
in the very rapid reversal of clinical and physiologic deficits, quicker with North
American ticks than with the Ixodes species seen in Australia.
KEYWORDS
Ticks - paralysis - compound muscle action potentials - repetitive nerve stimulation
- motor nerve terminal
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S. H SubramonyM.D.
Department of Neurology, University of Mississippi Medical Center
2500 North State Street, Jackson, MS 39216