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Journal of Neurology

, Volume 263, Issue 1, pp 17–24 | Cite as

Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review

  • R. DerschEmail author
  • H. Sommer
  • S. Rauer
  • J. J. Meerpohl
Original Communication

Abstract

Controversy exists about residual symptoms after pharmacological treatment of Lyme neuroborreliosis. Reports of disabling long-term sequels lead to concerns in patients and health care providers. We systematically reviewed the available evidence from studies reporting treatment of Lyme neuroborreliosis to assess the prevalence and spectrum of residual symptoms after treatment. A literature search was performed in three databases and three clinical trial registers to find eligible studies reporting on residual symptoms in patients after pharmacological treatment of LNB. Diagnosis must have been performed according to consensus-derived case definitions. No restrictions regarding study design or language were set. Symptom prevalence was pooled using a random-effects model. Forty-four eligible clinical trials and studies were found: 8 RCTs, 17 cohort studies, 2 case–control studies, and 17 case series. The follow-up period in the eligible studies ranged from 7 days to 20 years. The weighted mean proportion of residual symptoms was 28 % (95 % CI 23–34 %, n = 34 studies) for the latest reported time point. Prevalence of residual symptoms was statistically significantly higher in studies using the “possible” case definition (p = 0.0048). Cranial neuropathy, pain, paresis, cognitive disturbances, headache, and fatigue were statistically significantly lower in studies using the “probable/definite” case definition. LNB patients may experience residual symptoms after treatment with a prevalence of approximately 28 %. The prevalence and spectrum of residual symptoms differ according to the applied case definition. Symptoms like fatigue are not reported in studies using the “probable/definite” case definition. As the “possible” case definition is more unspecific, patients with other conditions may be included. Reports of debilitating fatigue and cognitive impairment after LNB, a “post-Lyme syndrome”, could therefore be an artifact of unspecific case definitions in single studies.

Keywords

Lyme disease Lyme neuroborreliosis Systematic review Prevalence review Residual symptoms Fatigue 

Notes

Compliance with ethical standards

Ethical standards

The manuscript does not contain a primary clinical study or patient data.

Conflicts of interest

SR reports receiving consulting and lecture fees, grant and research support from Bayer Vital GmbH, Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis, Baxter, RG, and Teva. Furthermore, SR indicates that he is a founding executive board member of ravo Diagnostika GmbH. All other authors (RD, HS and JJM) declare that they have no competing interests.

Supplementary material

415_2015_7923_MOESM1_ESM.docx (21 kb)
Supplementary material 1 Appendix 1: References to included studies (DOCX 21 kb)
415_2015_7923_MOESM2_ESM.pdf (9 kb)
Supplementary material Appendix 2: Characteristics of included studies2 (PDF 8 kb)
415_2015_7923_MOESM3_ESM.docx (18 kb)
Supplementary material 3 Appendix 3: Funnel plot of prevalence of residual symptoms in included studies. Prevalence is plotted against the reciprocal value of the sample size (larger studies are higher on the y-axis). (DOCX 18 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • R. Dersch
    • 1
    • 2
    Email author
  • H. Sommer
    • 3
  • S. Rauer
    • 1
  • J. J. Meerpohl
    • 2
  1. 1.Department of NeurologyMedical Center-University of FreiburgFreiburgGermany
  2. 2.German Cochrane CentreMedical Center-University of FreiburgFreiburgGermany
  3. 3.Institute of Medical Biometry and StatisticsMedical Center-University of FreiburgFreiburgGermany

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