Appropriate, critical application of evidence-based diagnostic criteria enables both a clear definition of what constitutes neuroborreliosis—nervous system infection with Borrelia burgdorferi sensu stricto in the US, B garinii and less commonly B. afzelii and other species in Europe—and recognition that this disorder is quite similar in Europe and the US. Most commonly evidenced by lymphocytic meningitis and/or multifocal inflammation of the peripheral (common; cranial neuropathy, radiculopathy, mononeuropathy multiplex) or central (rare) nervous system, it is readily diagnosed and highly antibiotic responsive. Encephalopathy—altered cognition or memory—can occur as part of the systemic infection and inflammatory state, but is not evidence of neuroborreliosis. Post treatment Lyme disease syndrome—persistent neurobehavioral symptoms 6 months or more after usually curative antibiotic treatment—if real and not simply an example of anchoring bias—is unrelated to neuroborreliosis. The pathophysiology of neuroborreliosis remains unclear, but appears to involve both a requirement for viable micro-organisms and significant immune amplification.
KeywordsNeuroborreliosis Lyme disease Lyme borreliosis B. burgdorferi Post treatment Lyme disease syndrome
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Conflicts of interest
The author has served as an expert defending physicians accused of failure to diagnose or treat Lyme disease. He declares there are no other conflicts of interest.
- 1.Garin C, Bujadoux A (1922) Paralysie par les tiques. J Med Lyon 71:765–767Google Scholar
- 8.Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I (2010) EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 17(1):8–16 (e1–e4) Google Scholar