Update Neuroborreliosis - New and Proven Options

Neuroborreliosis is a nervous system infection caused by Borrelia burgdorferi sensu lato. Lyme disease is the most frequent tick-borne infectious disease in Europe affecting the skin, joints, heart, nervous system and rarely the eyes. Since the discovery of the causative pathogen Borrelia burgdorferi 30 years ago, the rapid accumulation of knowledge about this disease has resulted in well-evaluated clinical and microbiological diagnostic guidelines. Today, neuroborreliosis can generally be diagnosed and treated successfully. Progress in microbiological research has led to improved serological tests with higher sensitivity and new approaches for early diagnosis of Lyme disease. Erythema migrans is the most frequent manifestation of Borrelia infection. It is diagnosed clinically. Neuroborreliosis is diagnosed by the combination of typical neurological symptoms, cerebrospinal fluid pleocytosis and Borrelia-specific antibodies produced intrathecally. In adults, erythema migrans is treated with doxycycline, in children with amoxicillin. Standard treatment of neuroborreliosis is ceftriaxone or cefotaxime i.v. Recent studies show similar efficacy of oral doxycycline in early neuroborreliosis. An appropriate antibiotic treatment eliminates the pathogen effectively. Repeated episodes of acute manifestations of Lyme disease in treated patients are probably due to reinfection and not to relapse. Only in a small proportion of treated patients is recovery from neuroborrelioses incomplete. In addition to neurological residual sequelae recent studies have detected persistent neuropsychological deficits in a small subgroup of patients. Conversely, when borreliosis is suspected by patients suffering from non-specific symptoms, a thorough clinical and laboratory assessment is required to identify other underlying diseases.