Opinion statement
Although estimates vary, the nervous system appears to be involved in 10% to 15% of patients infected with Borrelia burgdorferi. The resulting disorders, known collectively as neuroborreliosis or nervous system Lyme disease, generally respond well to antimicrobial therapy. Definitive treatment of nervous system infection typically consists of 2 to 4 weeks of parenteral ceftriaxone, cefotaxime, or high-dose penicillin (Class III). However, numerous European studies have shown that oral doxycycline is equally effective in patients with Lyme meningitis and cranial neuritis (Class II and III). This may be equally valid in patients infected with the strains prevalent in the United States, but this remains to be established.
Similar content being viewed by others
References and Recommended Reading
Ceftriaxone-associated biliary complications of treatment of suspected disseminated Lyme disease—New Jersey, 1990–1992. MMWR Morb Mortal Wkly Rep 1993, 42:39–42.
Garin C, Bujadoux A: Paralysie par les tiques. J Med Lyon 1922, 71:765–767.
Burgdorfer W, Barbour AG, Hayes SF, et al.: Lyme disease: a tick borne spirochetosis? Science 1982, 216:1317–1319.
Hellerstrom S: Erythema migrans Afzelius with meningitis. Acta Derm Venereol (Stockholm) 1951, 31:227–234.
Halperin JJ, Luft BJ, Volkman DJ, Dattwyler RJ: Lyme neuroborreliosis—peripheral nervous system manifestations. Brain 1990, 113:1207–1221.
Wormser GP, Dattwyler RJ, Shapiro ED, et al.: 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 2006, 43:1089–1134.
Halperin JJ, Shapiro ED, Logigian EL, et al.: Practice parameter: treatment of nervous system Lyme disease. Neurology 2007, In press.
Rand PW, Lubelczyk C, Holman MS, et al.: Abundance of Ixodes scapularis (Acari: Ixodidae) after the complete removal of deer from an isolated offshore island, endemic for Lyme disease. J Med Entomol 2004, 41:779–784.
Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Morb Mortal Wkly Rep 1997, 46:1–55.
Gerber MA, Shapiro ED, Burke GS, et al.: Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med 1996, 335:1270–1274.
Steere AC, Sikand VK: The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med 2003, 348:2472–2474.
Steere AC, Malawista SE, Hardin JA, et al.: Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Ann Intern Med 1977, 86:685–698.
Lyme disease—United States, 2001–2002. MMWR Morb Mortal Wkly Rep 2004, 53:365–369.
Reik L, Steere AC, Bartenhagen NH, et al.: Neurologic abnormalities of Lyme disease. Medicine 1979, 58:281–294.
Skogman BH, Croner S, Odkvist L: Acute facial palsy in children—a 2-year follow-up study with focus on Lyme neuroborreliosis. Int J Pediatr Otorhinolaryngol 2003, 67:597–602.
Kalina P, Decker A, Kornel E, Halperin JJ: Lyme disease of the brainstem. Neuroradiology 2005, 47:903–907.
Halperin J, Logigian E, Finkel M, Pearl R: Practice parameters for the diagnosis of patients with nervous system Lyme borreliosis (Lyme disease). Neurology 1996, 46:619–627.
Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep 1995, 44:590–591.
Peltomaa M, McHugh G, Steere AC: The VlsE (IR6) peptide ELISA in the serodiagnosis of lyme facial paralysis. Otol Neurotol 2004, 25:838–841.
Dressler F, Whalen JA, Reinhardt BN, Steere AC: Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 1993, 167:392–400.
Halperin JJ: Lyme disease and the peripheral nervous system. Muscle Nerve 2003, 28:133–143.
Eiffert H, Karsten A, Schlott T, et al.: Acute peripheral facial palsy in Lyme disease—a distal neuritis at the infection site. Neuropediatrics 2004, 35:267–273.
Halperin JJ: Facial nerve palsy associated with Lyme disease. Muscle Nerve 2003, 28:516–517.
Sibony P, Halperin J, Coyle P, Patel K: Reactive Lyme serology in optic neuritis. J Neuroophthalmol 2005, 25:71–82.
Jalladeau E, Pradat PF, Maisonobe T, Leger JM: Multiple mononeuropathy and inflammatory syndrome manifested in Lyme disease. Rev Neurol (Paris) 2001, 157:1290–1292.
Mormont E, Esselinckx W, De Ronde T, et al.: Abdominal wall weakness and lumboabdominal pain revealing neuroborreliosis: a report of three cases. Clin Rheumatol 2001, 20:447–450.
Gutknecht J, De Wazieres B, Fest T, Dupond JL: Guillain-Barré syndrome associated with Lyme disease. Presse Med 1994, 23:490.
Shapiro EE: Guillain-Barré syndrome in a child with serologic evidence of Borrelia. Pediatr Infect Dis J 1998, 17:264–265.
England JD, Bohm RP, Roberts ED, Philipp MT: Mononeuropathy multiplex in rhesus monkeys with chronic Lyme disease. Ann Neurol 1997, 41:375–384.
Vallat JM, Hugon J, Lubeau M, et al.: Tick bite meningoradiculoneuritis. Neurology 1987, 37:749–753.
Roberts ED, Bohm RP Jr, Lowrie RC Jr, et al.: Pathogenesis of Lyme neuroborreliosis in the rhesus monkey: the early disseminated and chronic phases of disease in the peripheral nervous system. J Infect Dis 1998, 178:722–732.
Holmgren AR, Matteson EL: Lyme myositis. Arthritis Rheum 2006, 54:2697–2700.
Karlsson M, Hammers S, Nilsson-Ehle I, et al.: Concentrations of doxycycline and penicillin G in sera and cerebrospinal fluid of patients treated for neuroborreliosis. Antimicrob Agents Chemother 1996, 40:1104–1107.
Klempner M, Hu L, Evans J, et al.: Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001, 345:85–92.
Kaplan RF, Trevino RP, Johnson GM, et al.: Cognitive function in post-treatment Lyme disease: do additional antibiotics help? Neurology 2003, 60:1916–1922.
Krupp LB, Hyman LG, Grimson R, et al.: Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology 2003, 60:1923–1930.
Fallon B, Sackheim H, Keilp J, et al.: Double-blind placebo-controlled retreatment with IV ceftriaxone for Lyme encephalopathy: clinical outcome. In Proceedings of the 10th International Conference on Lyme Borreliosis and Other Tick-borne Diseases. Vienna, Austria; 2005:196.
Halperin JJ: Treatment of Neuroborreliosis. Curr Treat Options Neurol 1999, 1:139–145.
Borg R, Dotevall L, Hagberg L, et al.: Intravenous ceftriaxone compared with oral doxycycline for the treatment of Lyme neuroborreliosis. Scand J Infect Dis 2005, 37:449–454.
Dotevall L, Hagberg L: Successful oral doxycycline treatment of Lyme disease-associated facial palsy and meningitis. Clin Infect Dis 1999, 28:569–574.
Karkkonen K, Stiernstedt S, Karlsson M: Follow-up of patients treated with oral doxycycline for Lyme neuroborreliosis. Scand J Infect Dis 2001, 33:259–262.
Karlsson M, Hammers-Berggren S, Lindquist L, et al.: Comparison of intravenous penicillin G and oral doxycycline for treatment of Lyme neuroborreliosis. Neurology 1994, 44:1203–1207.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Halperin, J.J. Diagnosis and treatment of the neuromuscular manifestations of Lyme disease. Curr Treat Options Neurol 9, 93–100 (2007). https://doi.org/10.1007/s11940-007-0035-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11940-007-0035-0