Neuroborreliosis is often preceded by the typical symptoms of Lyme disease, which includeerythema migrans and flu-like symptoms such as fever and muscle aches. Neurologic symptoms of neuroborreliosis include themeningoradiculitis (which is more common in European patients), cranial nerve abnormalities, and altered mental status. Sensory findings may also be present. Rarely, a progressive form ofencephalomyelitis may occur. In children, symptoms of neuroborreliosis include headache, sleep disturbance, and symptoms associated with increased intracranial pressure, such aspapilledema. Less common childhood symptoms can includemeningitis,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 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]
In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross theblood–brain barrier, such aspenicillins,ceftriaxone, orcefotaxime.[7] One relatively smallrandomized 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 oraldoxycycline is 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 ofBorrelia 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:
^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.PMID2897008.S2CID33352690.
^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.PMID9535244.
