From the Guidelines
Tick paralysis is a potentially serious condition caused by neurotoxins in tick saliva, and its symptoms typically begin with numbness or tingling in the extremities, followed by progressive ascending paralysis. The symptoms of tick paralysis can include muscle weakness, difficulty walking, incoordination, and in severe cases, respiratory failure if the paralysis affects breathing muscles 1. Other symptoms can include fatigue, irritability, and sometimes fever.
Key Symptoms
- Numbness or tingling in the extremities
- Progressive ascending paralysis starting in the legs and moving upward
- Muscle weakness
- Difficulty walking
- Incoordination
- Respiratory failure in severe cases
- Fatigue
- Irritability
- Fever
Treatment
The most critical treatment for tick paralysis is complete removal of the attached tick, which should be done carefully using fine-tipped tweezers to grasp the tick as close to the skin as possible and pull upward with steady pressure 1. After tick removal, symptoms usually begin to improve within hours and resolve completely within 1-3 days. No specific medication is required to treat tick paralysis itself, as removing the source of the toxin (the tick) stops the progression. However, supportive care may be necessary, particularly for patients with respiratory compromise who might need ventilatory support until recovery.
Prevention
Prevention is essential and includes:
- Wearing protective clothing in tick-infested areas
- Using insect repellents containing DEET or permethrin
- Performing regular tick checks after outdoor activities
- Promptly removing any attached ticks
From the Research
Symptoms of Tick Paralysis
- The classic clinical presentation of tick paralysis is the development of an unsteady, ataxic type gait followed by an acute symmetric ascending flaccid paralysis 2
- Symptoms generally begin within 2 to 6 days of tick attachment 2
- The weakness ascends to the upper extremities over a matter of hours, followed by cranial nerve involvement 2
- Patients may report minor sensory symptoms but constitutional signs are usually absent 3
- Deep tendon reflexes are usually hypoactive or absent and ophthalmoplegia and bulbar palsy can occur 3
- Children may be ataxic 3
- Paralysis can take different forms - from rare isolated cranial nerve infections to quadriplegia and respiratory muscles paralysis 4
Treatment of Tick Paralysis
- The mainstay of treatment for tick paralysis is tick removal 2
- The time to full neurologic recovery after tick removal is estimated to be around 1.5 days with initial improvement generally within hours 2
- Removal of the tick results in the very rapid reversal of clinical and physiologic deficits 3
- Some patients may require mechanical ventilation and support in an intensive care unit as the toxin clears 5
- Antimicrobials are not indicated since tick paralysis is toxin-mediated and not caused by an infectious agent 5
- Prevention of tick paralysis involves changing behavior to avoid tick exposure and performing frequent tick checks to remove them if they have already attached 5