Lyme and the Brain or Lyme Neurology

1: J Neurol Neurosurg Psychiatry. 2007 Oct;78(10):1160-1.
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Poliomyelitis-like syndrome with matching magnetic resonance features in a case of Lyme neuroborreliosis.

Charles V, Duprez TP, Kabamba B, Ivanoiu A, Sindic CJ.

Service de Neurologie, Cliniques Universitaires Saint-Luc, Universit� Catholique de Louvain, Brussels, Belgium.

Publication Types:
Case Reports

PMID: 17878200 [PubMed - indexed for MEDLINE]

2: 2007 Sep 4;69(10):953-8.
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Comment in:

  • Neurology. 2007 Sep 4;69(10):949-50.

Relevance of the antibody index to diagnose Lyme neuroborreliosis among seropositive patients.

Blanc F, Jaulhac B, Fleury M, de Seze J, de Martino SJ, Remy V, Blaison G, Hansmann Y, Christmann D, Tranchant C.

Department of Neurology, University Hospital of Strasbourg, Louis Pasteur University, Strasbourg, France. [email protected]

BACKGROUND: No consensual criteria exist to diagnose neuroborreliosis. The intrathecal anti-Borrelia antibody index (AI) is a necessary criterion to diagnose neuroborreliosis in Europe, but not in the United States. Previous studies to determine the diagnostic value of the AI found a sensitivity ranging from 55% to 80%. However, these studies included only typical clinical cases of meningitis or meningoradiculitis, and none had a control group with CSF anti-Borrelia antibodies. METHODS: We studied a sample of 123 consecutive patients with clinical signs of neurologic involvement and CSF anti-Borrelia antibodies. We determined the AI for all patients and a final diagnosis was made. Patients were then divided into three groups (neuroborreliosis, possible neuroborreliosis, control). RESULTS: Thirty of the 40 patients with neuroborreliosis had a positive AI (AI sensitivity = 75%). Two of the 74 patients with another neurologic diagnosis had a positive AI (AI specificity = 97%). CONCLUSION: The antibody index has a very good specificity but only moderate sensitivity. Given the lack of consensual criteria for neuroborreliosis and the absence of a "gold standard" diagnostic test, we propose pragmatic diagnostic criteria for neuroborreliosis, namely the presence of four of the following five items: no past history of neuroborreliosis, positive CSF ELISA serology, positive anti-Borrelia antibody index, favorable outcome after specific antibiotic treatment, and no differential diagnosis. These new criteria will need to be tested in a larger, prospective cohort.

PMID: 17785663 [PubMed - indexed for MEDLINE]

3: Acta Radiol. 2007 Sep;48(7):755-62.
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Brain magnetic resonance imaging does not contribute to the diagnosis of chronic neuroborreliosis.

Aalto A, Sj�wall J, Davidsson L, Forsberg P, Smedby O.

Division of Radiology, Department of Medicine and Care, Faculty of Health Sciences, Link�ping University, Link�ping, Sweden. [email protected]

BACKGROUND: Borrelia infections, especially chronic neuroborreliosis (NB), may cause considerable diagnostic problems. This diagnosis is based on symptoms and findings in the cerebrospinal fluid but is not always conclusive. PURPOSE: To evaluate brain magnetic resonance imaging (MRI) in chronic NB, to compare the findings with healthy controls, and to correlate MRI findings with disease duration. MATERIAL AND METHODS: Sixteen well-characterized patients with chronic NB and 16 matched controls were examined in a 1.5T scanner with a standard head coil. T1- (with and without gadolinium), T2-, and diffusion-weighted imaging plus fluid-attenuated inversion recovery (FLAIR) imaging were used. RESULTS: White matter lesions and lesions in the basal ganglia were seen in 12 patients and 10 controls (no significant difference). Subependymal lesions were detected in patients down to the age of 25 and in the controls down to the age of 43. The number of lesions was correlated to age both in patients (rho = 0.83, P<0.01) and in controls (rho = 0.61, P<0.05), but not to the duration of disease. Most lesions were detected with FLAIR, but many also with T2-weighted imaging. CONCLUSION: A number of MRI findings were detected in patients with chronic NB, although the findings were unspecific when compared with matched controls and did not correlate with disease duration. However, subependymal lesions may constitute a potential finding in chronic NB.

PMID: 17729007 [PubMed - indexed for MEDLINE]

4:  Wiad Lek.  2007;60(3-4):167-70.
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[Clinical spectrum of neuroborreliosis]
[Article in Polish]

Owecki MK, Kozubski W.

Katedry i Kliniki Neurologii, Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu. [email protected]

Lyme disease is a multisystem infectious disease with a wide variety of symptoms involving the skin as well as nervous, musculosceletal and cardiovascular systems. Lyme disease is caused by spirochaete Borrelia burgdorferi transmitted by Ixodes tics in endemic regions. The diverse manifestations of neuroborreliosis require it to be included in differential diagnosis of many neurological disorders. The paper reviews the spectrum of clinical symptoms of nervous system involvement in early and late Lyme disease.

Publication Types:

  • English Abstract
  • Review

PMID: 17726871 [PubMed - indexed for MEDLINE]

5: Lancet Neurol. 2007 Sep;6(9):756-7; author reply 757.
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Click here to read
Comment on:

  • Lancet Neurol. 2007 Jun;6(6):544-52.

Unexplained cerebral vasculitis and stroke: keep Lyme neuroborreliosis in mind.

Topakian R, Stieglbauer K, Aichner FT.

Publication Types:

  • Comment
  • Letter

PMID: 17706557 [PubMed - indexed for MEDLINE]

6:  Przegl Epidemiol. 2007;61(1):73-8.
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[Diagnostic difficulties in neuroborreliosis in children]
[Article in Polish]

Talarek E, Duszczyk E, Zarnowska H.

Klinika Chor�b Zakaznych Wieku Dzieciecego AM w Warszawie.

OBJECTIVE: Analysis of clinical picture in children hospitalized because of suspicion of neuroborreliosis and evaluation of usefulness of testing serum and cerebrospinal fluid (CSF) for specific antibodies. MATERIAL AND METHODS: 23 children (age: 13 months - 15.5 years) were hospitalized: 11 children with facial palsy, 2 children with radiculopathy and 10 children with headache. In 21 children lumbar puncture and CSF examination was done. Serum of all children and CSF of 21 children were tested by ELISA for specific antibodies (IDEIA DakoCytomation). RESULTS: Meningeal signs in physical examination were found in 4 children and inflammatory CSF changes in 8 children. Specific antibodies in sera of 19 children and in CSF of 7 children. Neuroborreliosis was diagnosed in 12 children: in 9 facial palsy (in 6 with inflammatory CSF changes), in 2 Bannwarth's syndrome and in 1 aseptic meningitis. Diagnosis was confirmed by detection of specific antibodies in sera of 10 children and in CSF of 6 children. CONCLUSIONS: Meningitis in the course of neuroborreliosis is not always accompanied by meningeal signs. Positive serology is not an unequivocal confirmation of neuroborreliosis especially if symptoms are nonspecific (e.g. headache).

Publication Types:

  • English Abstract

PMID: 17702442 [PubMed - indexed for MEDLINE]

7: Przegl Epidemiol. 2007;61(1):59-65.
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[Clinical forms of neuroborreliosis--the analysis of patients diagnosed in department of infectious diseases and neuroinfection medical academy in Bialystok between 2000-2005]
[Article in Polish]

Zajkowska J, Czupryna P, Kusmierczyk J, Ciemerych A, Ciemerych M, Kondrusik M, Pancewicz S, Grygorczuk S, Hermanowska-Szpakowicz T.

Klinika Chor�b Zakaznvch i Neuroinfekcii AM w Bialvmstoku.

Increased morbidity of viral tick borne encephalitis since the 90's indicates growing risk of Rother tick borne diseases, including neuroborreliosis. Analysis of demographical, epidemiological and clinical data of patients hospitalised in Departament on Infectious Diseases and Neuroinfections in years 2000-2005 revealed that among patients with Lyme disease 13% were with neuroborreliosis with broad spectrum of neurologic symptoms as cranial nerves paresis (mainly n.VII), as well concentration and memory disturbances, and general symptoms. Some of patiets did not recall tick bite and did not present earlier borreliosis symptoms. Imaging only supports recognitio.

Publication Types:

  • English Abstract

PMID: 17702440 [PubMed - indexed for MEDLINE]

8: Scand J Infect Dis. 2007;39(9):775-80.
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Antibodies to recombinant decorin-binding proteins A and B in the cerebrospinal fluid of patients with Lyme neuroborreliosis. Panelius J, Sillanp�� H, Sepp�l� I, Sarvas H, Lahdenne P.

Haartman Institute, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland. [email protected]

Cerebrospinal fluid (CSF) and serum samples from 34 patients with proven neuroborreliosis (NB) and 22 patients with suspected neuroborreliosis (SNB) from Finland were analysed for antibodies to decorin-binding proteins A (DbpA) and B (DbpB). Antibodies to recombinant protein antigens originating from Borrelia burgdorferi sensu stricto, B. afzelii, or B. garinii species were studied by enzyme-linked immunosorbent assay (ELISA). Of the 34 patients with NB, 100% of the CSF and 88% of the serum samples had IgG antibodies to 1 to 3 variants of DbpA and 79% of the CSF and 70% of the serum samples were positive for 1 to 3 DbpB variants. Antibodies to DbpB seemed to be associated with lymphocytic pleocytosis in the CSF and short duration of the disease, whereas antibodies to DbpA in the CSF were observed irrespective of the duration of the disease and lymphocytic pleocytosis. Among the variant antigens, CSF reactivity was mainly with the DbpB from B. garinii, whereas positivity with the DbpA from B. afzelii or B. garinii predominated. The results suggest that CSF antibodies to DbpB might be useful as a marker of active infection whereas antibodies to DbpA seem to persist a long time after acute phases of NB.

Publication Types:

  • Research Support, Non-U.S. Gov't

PMID: 17701715 [PubMed - in process]

9:  Pol Merkur Lekarski.2007 Apr;22(130):275-9.
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[Concentrations of pro-inflammatory cytokines IFN-gamma, IL-6, IL-12 and IL-15 in serum and cerebrospinal fluid in patients with neuroborreliosis undergoing antibiotic treatment]
[Article in Polish]

Pancewicz SA, Kondrusik M, Zajkowska J, Grygorczuk S.

Akademia Medyczna w Bialymstoku, Klinika Chor�b Zakaznych i Neuroinfekcji. [email protected]

Pathogenesis of Lyme disease, including neuroborreliosis, remains unclear. However, pro-inflammatory cytokines seem to be involved and might be used to monitor the course of the disease. It has been also shown that B. burgdorferi protects itself from elimination by modulating function of the host's immune system. THE AIM OF THIS STUDY: The purpose of this study was to evaluate the serum and cerebrospinal fluid (CSF) concentrations of selected cytokines in patients with neuroborreliosis and their change during antibiotic treatment. MATERIAL AND METHODS: The group of 25 patients was examined, all undergoing antibiotic therapy due to meningitis caused by Borrelia burgdorferi infection. The group included 10 (40%) females and 15 (60%) males in the mean age x = 42,3 years. The control group for serum measurements consisted of 25 healthy individuals (mean age x =43, 1) while control group for CSF study included 10 patients (aged x = 53,5 years) from whom CSF with normal parameters was taken during diagnostic procedures neurosurgical. We examined serum and CSF before and after antibiotics for concentrations of interferon-gamma (INF-gamma), interleukin-6 (IL-6), interleukin-12 (IL-12) and interleukin-15 (IL-15). RESULTS: In the first examination the significant increase of IFN-gamma, IL-6, IL-2, IL-15 serum and CSF concentration was detected in comparison to control group. After 4-weeks antibiotic treatment the concentrations of studied cytokines decreased significantly in serum as well as in CSF but remained increased in comparison with controls. CONCLUSIONS: Although antibiotic treatment leads to withdrawal of clinical symptoms of neuroborreliosis and normalization of CSF general parameters, pro-inflammatory cytokines' concentrations in serum and CSF remain elevated. It may be explained by the persistence of inflammatory conditions, perhaps related to surviving of a fraction of Borrelia burgdorferi spirochetes within CNS tissue. This phenomenon might lead to development of chronic CNS lesions.

Publication Types:

  • Clinical Trial
  • English Abstract

PMID: 17684925 [PubMed - indexed for MEDLINE]

10: Eur J Neurol. 2007 Aug;14(8):873-6.
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Clinical usefulness of intrathecal antibody testing in acute Lyme neuroborreliosis.
Lj�stad U, Skarpaas T, Mygland A.
Department of Neurology, S�rlandet Sykehus HF, Kristiansand, Norway. [email protected]

The aim of the study was to examine diagnostic sensitivity and temporal course of intrathecal Borrelia burgdorferi (Bb) antibody production in acute Lyme neuroborreliosis (LNB). We recruited consecutive adult patients with LNB diagnosis based on strict selection criteria. Serum and cerebrospinal fluid (CSFs) were obtained, and clinical examination was performed pre-treatment, and 13 days and 4 months post-treatment. Pre-treatment positive Bb antibody index (AI) was detected in 34 of 43 (79%). All nine pre-treatment Bb AI negative patients, and 26 of 34 pre-treatment Bb AI positive patients reported symptom duration <6 weeks. Eight patients, all Bb AI positive, reported symptom duration of 6 weeks or longer. Consequently, pre-treatment diagnostic sensitivity of Bb AI was 74% when symptom duration was <6 weeks, and 100% when 6 weeks or longer. Three patients converted from negative to positive Bb AI status post-treatment. The six patients who were persistently Bb AI negative had lower CSF cell count and protein at presentation, when compared with the patients with positive Bb AI. In conclusion, the diagnostic sensitivity of Bb AI is suboptimal in acute early LNB. Repeated post-treatment Bb AI testing, to confirm or reject LNB diagnosis, is unreliable, as the majority of initial Bb AI negative patients remained negative at follow-up.

Publication Types:

  • Research Support, Non-U.S. Gov't

PMID: 17662007 [PubMed - indexed for MEDLINE]

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