Neuroborreliosis

Neuroborreliosis is a disorder of the central nervous system. A neurological manifestation of Lyme disease, neuroborreliosis is caused by a systemic infection of spirochetes of the genus Borrelia.[1] Symptoms of the disease include erythema migrans and flu-like symptoms.[2]

Neuroborreliosis
Other namesLyme neuroborreliosis (LNB)
SpecialtyInfectious diseases 

Signs and symptoms

Neuroborreliosis is often preceded by the typical symptoms of Lyme disease, which include erythema migrans and flu-like symptoms such as fever and muscle aches. Neurologic symptoms of neuroborreliosis include the meningoradiculitis (which is more common in European patients), cranial nerve abnormalities, and altered mental status. Sensory findings may also be present. Rarely, a progressive form of encephalomyelitis may occur. In children, symptoms of neuroborreliosis include headache, sleep disturbance, and symptoms associated with increased intracranial pressure, such as papilledema. Less common childhood symptoms can include meningitis, myelitis, ataxia, and chorea. Ocular Lyme disease has also been reported, as has neuroborreliosis affecting the spinal cord, but neither of these findings are common.[3]

Diagnosis

Differential diagnosis

A number of diseases can produce symptoms similar to those of Lyme neuroborreliosis. They include:

Diagnosis is determined by clinical examination of visible symptoms.[5] Neuroborreliosis can also be diagnosed serologically to confirm clinical examination via western blot, ELISA, and PCR.[6]

Treatment

In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross the blood–brain barrier, such as penicillins, ceftriaxone, or cefotaxime.[7] One relatively small randomized controlled trial suggested ceftriaxone was more effective than penicillin in the treatment of neuroborreliosis.[8] Small observational studies suggest ceftriaxone is also effective in children.[9] The recommended duration of treatment is 14 to 28 days.[10][11]

Several studies from Europe have suggested oral doxycycline is equally as effective as intravenous ceftriaxone in treating neuroborreliosis. Doxycycline has not been widely studied as a treatment in the US, but antibiotic sensitivities of prevailing European and US isolates of Borrelia burgdorferi tend to be identical. However, doxycycline is generally not prescribed to children due to the risk of bone and tooth damage.[7]

Discredited treatments for neuroborreliosis include:

See also

References
  1. Rupprecht, Tobias A; Koedel, Uwe; Fingerle, Volker; Pfister, Hans-Walter (2008). "The Pathogenesis of Lyme Neuroborreliosis: From Infection to Inflammation". Molecular Medicine. 14 (3–4): 205–12. doi:10.2119/2007-00091.Rupprecht. PMC 2148032. PMID 18097481.
  2. Koedel, Uwe; Fingerle, Volker; Pfister, Hans-Walter (2015-08-01). "Lyme neuroborreliosis-epidemiology, diagnosis and management". Nature Reviews. Neurology. 11 (8): 446–456. doi:10.1038/nrneurol.2015.121. ISSN 1759-4766. PMID 26215621. S2CID 13694627.
  3. Hildenbrand, P.; Craven, D.E.; Jones, R.; Nemeskal, P. (2009). "Lyme Neuroborreliosis: Manifestations of a Rapidly Emerging Zoonosis". American Journal of Neuroradiology. 30 (6): 1079–87. doi:10.3174/ajnr.A1579. PMC 7051319. PMID 19346313.
  4. Lyme Disease at eMedicine
  5. Meyerhoff JO, Zaidman GW and Steele RW for Medscape Drugs & Diseases, Eds. Diamond HS et al. Lyme Disease Differential Diagnoses: Diagnostic Considerations Updated: Mar 14, 2016
  6. CDC Two-step Laboratory Testing Process Page last reviewed: March 4, 2015. Page last updated: March 26, 2015
  7. Halperin, John J. (June 2008). "Nervous System Lyme Disease". Infectious Disease Clinics of North America. 22 (2): 261–74, vi. doi:10.1016/j.idc.2007.12.009. PMID 18452800. S2CID 10590435.
  8. Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ (May 1988). "Treatment of late Lyme borreliosis—randomised comparison of ceftriaxone and penicillin". Lancet. 1 (8596): 1191–4. doi:10.1016/s0140-6736(88)92011-9. PMID 2897008. S2CID 33352690.{{cite journal}}: CS1 maint: uses authors parameter (link)
  9. Bloom, Bradley J.; Wyckoff, Patricia M.; Meissner, H. Cody; Steere, Allen C. (March 1998). "Neurocognitive abnormalities in children after classic manifestations of Lyme disease". The Pediatric Infectious Disease Journal. 17 (3): 189–96. doi:10.1097/00006454-199803000-00004. PMID 9535244.
  10. Wormser, G. P.; Dattwyler, R. J.; Shapiro, E. D.; Halperin, J. J.; Steere, A. C.; Klempner, M. S.; Krause, P. J.; Bakken, J. S.; Strle, F.; Stanek, G.; Bockenstedt, L.; Fish, D.; Dumler, J. S.; Nadelman, R. B. (November 2006). "The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
  11. Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T. (July 2007). "Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. PMID 17522387.
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