Journal of Neurology

, Volume 235, Issue 3, pp 140–142 | Cite as

Chronic borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy

  • H. H. Kollikowski
  • G. Schwendemann
  • M. Schulz
  • H. Wilhelm
  • H. -J. Lehmann
Original Investigations


A 57-year-old male was repeatedly admitted to hospital because of complex neurological symptoms, including radicular pain, disturbance of micturition, seizures, and severely impaired mental state. The diagnosis was encephalomyeloradiculitis possibly of viral origin, and treatment with immunosuppressants was initiated. An alternating course with a tendency towards improvement ensued. Two and a half years after the occurrence of the initial symptoms, identification of specific antibodies in the blood and CSF led to the diagnosis of borreliosis with CNS involvement. High-dose therapy with penicillin rapidly reduced the symptoms, beginning with those of radicular pain and followed by an improvement of the mental state. Attention is directed to the wide spectrum of clinical symptoms of chronic borreliosis with CNS involvement. Previous reports that immunosuppression may result in some improvement but with a tendency towards relapse are confirmed. Our encouraging treatment results support those of other reports that penicillin therapy may lead to improvement even at late chronic stages in patients with severe CNS deficits.

Key words

Borrelia burgdorferi Lyme disease Chronic encephalomyeloradiculitis Erythema chronicum migrans Penicillin 


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  1. 1.
    Ackermann R (1983) Erythema chronicum migrans und durch Zecken übertragene Meningopolyneuritis (Garin-Bujadoux-Bannwarth): Borrelien-Infektionen? Dtsch Med Wochenschr 108:577Google Scholar
  2. 2.
    Ackermann R (1986) Erythema-migrans-Borreliose und Frühsommer-Meningoencephalitis. Dtsch Ärztebl 83:1765–1774Google Scholar
  3. 3.
    Ackermann R, Kabatzki J, Doisten HP, Runnei U, Steere AC, Grodzicki RL, Hartung S (1984) Spirochäten-Ätiologie der Erythema chronicum-migrans-Krankheit. Dtsch Med Wochenschr 109:92Google Scholar
  4. 4.
    Ackermann R, Gollmer E, Rhese-Küpper B (1985) Progressive Borrelien-Encephalomyelitis. Dtsch Med Wochenschr 110:1039–1042Google Scholar
  5. 5.
    Benach JL, Bosler EM, Hanrahn JP, Choleman JL, Habicht GS, Bast TF, Cameron DJ, Ziegler JL, Barbour AG, Burgdorfer W, Edelman R, Kaslow RA (1983) Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med 308:740Google Scholar
  6. 6.
    Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grundwaldt JP, Davis JP (1982) Lyme disease — a tick-borne-spirochetosis? Science 216:1317Google Scholar
  7. 7.
    Burgdorfer W, Barbour AG, Hayes SF, Peter O, Aeschlimann A (1983) Erythema chronicum migrans — a tick-borne spirochetosis. Acta Trop (Basel) 40:79–83Google Scholar
  8. 8.
    Christen H-J, Delekat D, Rating D, Hanefeld F (1985) Erythema migrans-Krankheit — Drei Fallbeispiele mit neurologischen Komplikationen. Monatsschr Kinderheilkd 133:732–737Google Scholar
  9. 9.
    Garin C, Bujadoux C (1922) Paralysis par les tiques. J Med Lyon 71:765–767Google Scholar
  10. 10.
    Klenk W, Heitmann R, Ackermann R (1985) Rezidivierende Erythema-chronicum-migrans-Krankheit des Nervensystems: Garin-Bujadoux-Bannwarth, Kasuistik. Aktuel Neurol 12:20–23Google Scholar
  11. 11.
    Kohler J, Kaper J, Kern U, Thoden U, Rhese-Küpper B (1986) Borrelia encephalomyelitis. Lancet II:35Google Scholar
  12. 12.
    Pachner AMD, Steere AC (1985) The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 35:47–53Google Scholar
  13. 13.
    Preac-Mursic V, Schierz G, Pfister HW, Einhäupl K, Wilske B, Weber K (1984) Isolierung einer Spirochäte aus Liquor cerebrospinalis bei Meningoradikulitis Bannwarth. Münch Med Wochenschr 126:275Google Scholar
  14. 14.
    Raucher HS, Kaufman DM, Goldfarb J, Jacobson RI, Roseman B, Wolff RR (1985) Pseudotumor cerebri and Lyme disease: a new association. J Pediatr 107:931–933Google Scholar
  15. 15.
    Reik L, Smith L, Khan A, Nelson W (1985) Demyelinating encephalopathy in Lyme disease. Neurology 35:267–269Google Scholar
  16. 16.
    Reik L, Burgdorfer W, Donaldson JO (1986) Neurologic abnormalities in Lyme disease without erythema chronicum migrans. Am J Med 81:73–78Google Scholar
  17. 17.
    Ryberg B, Nilsson B, Burgdorfer W, Barbour AG (1983) Antibodies to Lyme disease — spirochete in European lymphocytic meningo-radiculitis (Bannwarth's syndrome). Lancet II:519Google Scholar
  18. 18.
    Satz N, Ott A, Zogg F, Knoblauch M (1986) Die Erythema-migrans-Krankheit. Schweiz Med Wochenschr 116:763–769Google Scholar
  19. 19.
    Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, Burgdorfer W, Schmid GP, Johnson E, Malawista SE (1983) The spirochetal etiology of Lyme disease. N Engl J Med 308:733Google Scholar
  20. 20.
    Weder B, Wiedersheim P, Matter L, Steck A, Otto F (1987) Chronic progressive neurological involvement in Borrelia burgdorferi infection. J Neurol 234:40–43Google Scholar
  21. 21.
    Wörth WD (1985) Diagnostik der Erythema migrans-Krankheit (Lyme-Krankheit). Dtsch Med Wochenschr 110:1377–1379Google Scholar
  22. 22.
    Wörth WD (1985) Therapie der Erythema migrans-Krankheit (Lyme-Krankheit). Dtsch Med Wochenschr 110:1379–1380Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • H. H. Kollikowski
    • 1
  • G. Schwendemann
    • 1
  • M. Schulz
    • 1
  • H. Wilhelm
    • 1
  • H. -J. Lehmann
    • 1
  1. 1.Neurologische Universitätsklinik und Poliklinik EssenEssenFederal Republic of Germany

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