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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 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
Bell's 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

References

^ Rupprecht TA, Koedel U, Fingerle V, Pfister HW (2008). "The pathogenesis of lyme neuroborreliosis: from infection to inflammation" (PDF). Mol. Med. 14 (3–4): 205–12. doi:10.2119/2007-00091.Rupprecht. PMC 2148032. PMID 18097481.
^ 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.ajnr.org/cgi/content/full/30/6/1079
^ http://emedicine.medscape.com/article/1168285-diagnosis
^ http://www2.lymenet.org/8525647f006e05f2/8c703fae46ce57c28525670a0009ab7e/42c29e795a2341938525650300056eea?OpenDocument
^ ^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.
^ 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.
^ 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.
^ 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.
^ 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.

UpToDate Contents

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1. 神経系のライム病 nervous system lyme disease
2. 成人におけるライム病の臨床症状 clinical manifestations of lyme disease in adults
3. ライム病の治療 treatment of lyme disease
4. 多発神経根症：脊柱管狭窄症、感染症、癌、および炎症性神経根症候群 polyradiculopathy spinal stenosis infectious carcinomatous and inflammatory nerve root syndromes
5. ベル麻痺：成人における病因、臨床的特徴、および診断 bells palsy pathogenesis clinical features and diagnosis in adults

English Journal

Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis - a systematic review.

Dersch R1,2, Freitag MH3, Schmidt S1,4, Sommer H1,5, Rauer S2, Meerpohl JJ1.
European journal of neurology : the official journal of the European Federation of Neurological Societies.Eur J Neurol.2015 Sep;22(9):1249-59. doi: 10.1111/ene.12744. Epub 2015 Jun 8.
BACKGROUND AND PURPOSE: Our aim was to evaluate the available evidence for pharmacological treatment of acute Lyme neuroborreliosis as a basis for evidence-based clinical recommendations in a systematic review.METHODS: A systematic literature search of Medline, EMBASE, the Cochrane Library and three
PMID 26058321

Reply: On the radar: Lyme neuroborreliosis, an infectious cause of cerebral vasculitis.

Spath NB1, Amft N2, Farquhar D2.
QJM : monthly journal of the Association of Physicians.QJM.2015 Sep;108(9):756. doi: 10.1093/qjmed/hcv040. Epub 2015 Feb 5.
PMID 25660611

On the radar: Lyme neuroborreliosis, an infectious cause of cerebral vasculitis.

Pearson S.
QJM : monthly journal of the Association of Physicians.QJM.2015 Sep;108(9):755. doi: 10.1093/qjmed/hcv043. Epub 2015 Feb 5.
PMID 25660609

Japanese Journal

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症例は53歳女性．2013年8月下旬にマダニ咬傷を受傷．同年10月中旬から40°C台の発熱が出現し，下旬より，左眼中心視野障害，左末梢性顔面神経麻痺をみとめ，当科入院．入院時神経学的所見で，左末梢性顔面神経麻痺，左眼中心暗点，左上下肢失調，体幹失調をみとめた．血液検査で炎症反応と髄液検査で軽度の細胞数増多をみとめた．頭部MRIは異常なく，眼底所見にて左視神経乳頭炎が示唆された．抗菌薬，ステロイドパ …
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永田龍世,稲森由恵,髙田良治 [他]
臨床神経学 = Clinical neurology 54(2), 146-150, 2014-02
NAID 40019969430

T細胞型悪性リンパ腫を併発した神経ボレリア症の1例

永田龍世,稲森由恵,髙田良治,池田賢一,渡邊修,髙嶋博
臨床神経学 54(2), 146-150, 2014
症例は80歳男性である．両側性末梢性顔面神経麻痺，四肢筋力低下，四肢末梢・会陰部の感覚障害，尿閉，便秘，四肢腱反射消失をみとめた．バゾプレシン分泌過剰症（syndrome of inappropriate antidiuretic hormone secretion; SIADH），脳脊髄液細胞増多・蛋白上昇をみとめ，セフトリアキソンおよびステロイドパルス治療にて神経症状はすみやかに改善した．脳脊 …
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