Neuroborreliosis

Neuroborreliosis
Classification and external resources
MeSH	D020852

Neuroborreliosis is a disorder of the central nervous system caused by infection with a spirochete of the genus Borrelia.^[1] The microbiological progression of the disease is similar to that of neurosyphilis, another spirochetal infection.^[2] Neuroborreliosis occurs as a rare manifestation of late Lyme disease, although it has also been reported during early infection.

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, can occur. 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]

Differential diagnosis

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

• Alzheimer's disease
• Acute disseminated encephalomyelitis
• Viral meningitis
• Multiple sclerosis
• Bells palsy^[4]

Neuroborreliosis presenting with symptoms consistent with amyotrophic lateral sclerosis has been described.^[5]

Treatment

In the US, neuroborreliosis is typically treated with intravenous antibiotics which cross the blood-brain barrier, such as penicillins, ceftriaxone, or cefotaxime.^[6] One relatively small randomized controlled trial suggested ceftriaxone was more effective than penicillin in the treatment of neuroborreliosis.^[7] Small observational studies suggest ceftriaxone is also effective in children.^[8] The recommended duration of treatment is 14 to 28 days.^[9][10]

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.^[6]

Discreditied or doubtful treatments for neuroborreliosis include:

• Malariotherapy
• Hyperbaric oxygen therapy
• Colloidal silver
• Injections of hydrogen peroxide and bismacine

See also

• Tick-borne disease

References

1. ^ Rupprecht TA, Koedel U, Fingerle V, Pfister HW (2008). "The pathogenesis of lyme neuroborreliosis: from infection to inflammation". Mol. Med. 14 (3–4): 205–12. doi:10.2119/2007-00091.Rupprecht. PMC 2148032. PMID 18097481. http://www.molmed.org/pdfstore/205_212.Rupprecht.00091.PDF. 
2. ^ Judith Miklossy, Sandor Kasas, Anne D Zurn, Shermann McCall, Sheng Yu, and Patrick L McGeer (2008). "Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis". Journal of Neuroinflammation 5 (1): 40. doi:10.1186/1742-2094-5-40. PMC 2564911. PMID 18817547. http://www.jneuroinflammation.com/content/5/1/40. 
3. ^ http://www.ajnr.org/cgi/content/full/30/6/1079
4. ^ http://emedicine.medscape.com/article/1168285-diagnosis
5. ^ http://www2.lymenet.org/8525647f006e05f2/8c703fae46ce57c28525670a0009ab7e/42c29e795a2341938525650300056eea?OpenDocument
6. ^ ^{a b} Halperin JJ (June 2008). "Nervous system Lyme disease". Infect. Dis. Clin. North Am. 22 (2): 261–74, vi. doi:10.1016/j.idc.2007.12.009. PMID 18452800. 
7. ^ 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. PMID 2897008. 
8. ^ Bloom BJ, Wyckoff PM, Meissner HC, Steere AC (March 1998). "Neurocognitive abnormalities in children after classic manifestations of Lyme disease". Pediatr. Infect. Dis. J. 17 (3): 189–96. doi:10.1097/00006454-199803000-00004. PMID 9535244. 
9. ^ Wormser GP, Dattwyler RJ, Shapiro ED, et al. (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". Clin. Infect. Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130. 
10. ^ Halperin JJ, Shapiro ED, Logigian E, et al. (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.