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Practice Guideline
. 2020 Feb 27:18:Doc03.
doi: 10.3205/000279. eCollection 2020.

Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis

Sebastian Rauer  1 , Stephan Kastenbauer  1 , Heidelore Hofmann  2 , Volker Fingerle  3 , Hans-Iko Huppertz  4   5 , Klaus-Peter Hunfeld  6   7 , Andreas Krause  8 , Bernhard Ruf  9 , Rick Dersch  1   10 ; Consensus group
Affiliations
Practice Guideline

Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis

Sebastian Rauer et al. Ger Med Sci. .

Abstract
in English, German

Lyme borreliosis is the most common tick-borne infectious disease in Europe. A neurological manifestation occurs in 3-15% of infections and can manifest as polyradiculitis, meningitis and (rarely) encephalomyelitis. This S3 guideline is directed at physicians in private practices and clinics who treat Lyme neuroborreliosis in children and adults. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany). The main objectives of this guideline are to define the disease and to give recommendations for the confirmation of a clinically suspected diagnosis by laboratory testing, antibiotic therapy, differential diagnostic testing and prevention.

Die Lyme-Borreliose ist die häufigste durch Zecken übertragene Infektionskrankheit in Europa. Eine neurologische Manifestation kommt bei 3–15% der Infektionen vor und kann sich als Polyradikulitis, Meningitis sowie selten als Enzephalomyelitis manifestieren. Die Erkrankung ist durch Antibiotika behandelbar.Diese S3-Leitlinie richtet sich an Ärzte in Praxis und Klinik, die mit der Behandlung der Neuroborreliose bei Kindern und Erwachsenen befasst sind.An der Entwicklung waren 20 AWMF-Mitgliedsgesellschaften, das Robert Koch-Institut, die Deutsche Borreliose-Gesellschaft und 3 Patientenorganisationen beteiligt. Die systematische Literaturrecherche und Literaturbewertung wurden durch das Deutsche Cochrane Zentrum Freiburg (Cochrane Deutschland) durchgeführt.Hauptziele der Leitlinie sind es, die Krankheit zu definieren und Empfehlungen abzugeben zur Bestätigung der Verdachtsdiagnose mittels Laboruntersuchungen, Antibiotikabehandlung, Differenzialdiagnostik und Prävention.

Keywords: Bannwarth’s syndrome; Borrelia burgdorferi infection; Lyme borreliosis; Lyme disease; encephalomyelitis; facial palsy; ixodid tick-borne borreliosis; lymphocytic meningoradiculitis; meningitis; polyneuropathy; polyradiculitis.

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Figures

Table 1
Table 1. Cerebrospinal fluid results for early and late manifestations of Lyme neuroborreliosis prior to antibiotic treatment
Table 2
Table 2. Antibody detection and test sensitivity based on disease stage (modified according to [85])
Table 3
Table 3. Routine lab parameters for patients with early or late manifestations of Lyme neuroborreliosis [47]
Table 4
Table 4. Systematic evaluation of the frequency of persistent symptoms following the treatment of Lyme neuroborreliosis in relation to diagnostic certainty (probable/confirmed vs. possible) (modified according to [5])
Table 5
Table 5. Overview of antibiotic treatment
Figure 1
Figure 1. Diagnostic algorithm for early Lyme neuroborreliosis; modified according to [43]
Figure 2
Figure 2. Diagnostic algorithm for late Lyme neuroborreliosis; modified according to [43]
See this image and copyright information in PMC

References

    1. Deutsche Gesellschaft für Dermatologie. S2k Leitlinie Kutane Lyme Borreliose. AWMF-Register No. 013-044. Berlin: AWMF; 2016. Available from: https://www.awmf.org/uploads/tx_szleitlinien/013-044l_S2k_Kutane_Lyme_Bo....
    1. Deutsche Gesellschaft für Neurologie. S1 Leitlinie Neuroborreliose. AWMF Register No. 030-071. Berlin: AWMF; 2012.
    1. Dersch R, Hottenrott T, Schmidt S, Sommer H, Huppertz HI, Rauer S, Meerpohl JJ. Efficacy and safety of pharmacological treatments for Lyme neuroborreliosis in children: a systematic review. BMC Neurol. 2016 Sep;16(1):189. doi: 10.1186/s12883-016-0708-y. doi: 10.1186/s12883-016-0708-y. Available from: - DOI - DOI - PMC - PubMed
    1. Dersch R, Freitag MH, Schmidt S, Sommer H, Rauer S, Meerpohl JJ. Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis – a systematic review. Eur J Neurol. 2015 Sep;22(9):1249–1259. doi: 10.1111/ene.12744. doi: 10.1111/ene.12744. Available from: - DOI - DOI - PubMed
    1. Dersch R, Sommer H, Rauer S, Meerpohl JJ. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. J Neurol. 2016 Jan;263(1):17–24. doi: 10.1007/s00415-015-7923-0. doi: 10.1007/s00415-015-7923-0. Available from: - DOI - DOI - PubMed

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