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. 2018 Nov 9;115(45):751-756.
doi: 10.3238/arztebl.2018.0751.

Lyme Neuroborreliosis

Sebastian Rauer  1 , Stefan Kastenbauer, Volker Fingerle, Klaus-Peter Hunfeld, Hans-Iko Huppertz, Rick Dersch
Affiliations

Lyme Neuroborreliosis

Sebastian Rauer et al. Dtsch Arztebl Int. .

Abstract

Background: The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and treatment of this disease.

Methods: The scientific literature was systematically searched and the retrieved publications were assessed at the German Cochrane Center (Deutsches Cochrane Zentrum) in Freiburg in the 12 months beginning in March 2014. In addition to the main search terms "Lyme disease," "neuroborreliosis," "Borrelia," and "Bannwarth," 28 further terms relating to neurological manifestations of the disease were used for the search in the Medline and Embase databases and in the Cochrane Central Register of Controlled Trials.

Results: In the treatment of early Lyme neuroborreliosis, orally administered doxycycline is well tolerated, and its efficacy is equivalent to that of intravenously administered beta-lactam antibiotics (penicillin G, ceftriaxone, and cefotaxime) (relative risk [RR]: 0.98, 95% confidence interval [CI]: [0.68; 1.42], P = 0.93). 14 days of treatment suffice for early Lyme neuroborreliosis, and 14-21 days of treatment usually suffice for late (chronic) Lyme neuroborreliosis.

Conclusion: Lyme neuroborreliosis has a favorable prognosis if treated early. The long-term administration of antibiotics over many weeks or even months for putative chronic Lyme neuroborreliosis with nonspecific symptoms yields no additional benefit and carries the risk of serious adverse effects.

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Figures

Figure
Figure
Flowchart of the included studies
eFigure 1
eFigure 1
Diagnostic algorithm for early Lyme neuroborreliosis (4) PCR, polymerase chain reaction; CXCL, C-X-C motif chemokine ligand
eFigure 2
eFigure 2
Diagnostic algorithm for late Lyme neuroborreliosis (4). AB, antibody; B., Borrelia
See this image and copyright information in PMC

Comment in

  • Critical Comments.
    Berghoff W, Hopf-Seidel P, Weitkus B, Steiner C. Berghoff W, et al. Dtsch Arztebl Int. 2019 May 10;116(19):344. doi: 10.3238/arztebl.2019.0344a. Dtsch Arztebl Int. 2019. PMID: 31288911 Free PMC article. No abstract available.
  • Additions.
    Haufs MG. Haufs MG. Dtsch Arztebl Int. 2019 May 10;116(19):344-345. doi: 10.3238/arztebl.2019.0344b. Dtsch Arztebl Int. 2019. PMID: 31288912 Free PMC article. No abstract available.

References

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    1. Dersch R, Freitag MH, Schmidt S, et al. Efficacy and safety of pharmacological treatments for neuroborreliosis—protocol for a systematic review. Syst Rev. 2014;3 - PMC - PubMed
    1. Dersch R, Freitag MH, Schmidt S, et al. Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis—a systematic review. Eur J Neurol. 2015;22:1249–1259. - PubMed
    1. Rauer S, Kastenbauer S, et al. S3 Leitlinie Neuroborreliose Deutsche Gesellschaft für Neurologie (ed.) 2018. Leitlinien für Diagnostik und Therapie in der Neurologie. www.dgn.org/leitlinien
    1. Oschmann P, Dorndorf W, Hornig C, et al. Stages and syndromes of neuroborreliosis. J Neurol. 1998;245:262–272. - PubMed

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