Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;31(12):e16487.
doi: 10.1111/ene.16487. Epub 2024 Sep 19.

Clinical and laboratory characteristics during a 1-year follow-up in European Lyme neuroborreliosis: A prospective cohort study

Anne Marit Solheim  1   2 , Ingerid Skarstein  3   4 , Hanne Quarsten  5 , Åslaug Rudjord Lorentzen  1   6 , Pål Berg-Hansen  7 , Randi Eikeland  6   8 , Harald Reiso  6 , Åse Mygland  1   2   9 , Unn Ljøstad  1   2
Affiliations

Clinical and laboratory characteristics during a 1-year follow-up in European Lyme neuroborreliosis: A prospective cohort study

Anne Marit Solheim et al. Eur J Neurol. 2024 Dec.

Abstract

Background and purpose: We need more knowledge on clinical presentations, time course, biomarkers, and prognosis in European Lyme neuroborreliosis (LNB).

Methods: A prospective 12-month follow-up of predetermined clinical and laboratory parameters was undertaken in 105 patients with LNB.

Results: At presentation, 79% had radiculopathy, 49% had facial palsy, and 13% had solely subjective symptoms (predominately pain). Intrathecally produced Borrelia burgdorferi (Bb) antibodies were demonstrated and cerebrospinal fluid (CSF) CXCL13 was positive in 85% and 82% pretreatment, in 73% and 10% at 6 months, and in 58% and 14% at 12 months, respectively. CSF Bb polymerase chain reaction (PCR) was positive in 40% pretreatment. In four patients who tested negative for Bb antibodies in both serum and CSF, the diagnosis was supported by typical clinical features, pleocytosis, CSF Bb-PCR (n = 1), or CSF CXCL13 (n = 2). The proportion with symptoms influencing daily life was 91% pretreatment, 25% at 10 weeks, 20% at 6 months, and 15% at 12 months. Fatigue was the most common complaint at 12 months. A high burden of symptoms before and after treatment was associated with residual complaints at 12 months, whereas background data, other clinical features, and laboratory features were not.

Conclusions: LNB can present with solely subjective symptoms, especially pain. Many LNB patients have persistent Bb antibodies in serum and CSF. In seronegative LNB, CSF Bb-PCR and CXCL13 may give diagnostic support. CXCL13 may be persistently positive after treatment in some patients. Most of the clinical improvement occurs during the first 10 weeks. High initial clinical score is associated with poorer outcome.

Keywords: biomarkers; case definition; clinical characteristics; neuroborreliosis; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Diagram of the study population at the different times of follow‐up. Included patients from November 2015 to January 2020 from seven hospitals in South Norway are shown.
FIGURE 2
FIGURE 2
Symptoms and findings as scored on the composite clinical score variables at different times of follow‐up.
See this image and copyright information in PMC

References

    1. Halperin JJ, Eikeland R, Branda JA, Dersch R. Lyme neuroborreliosis: known knowns, known unknowns. Brain J Neurol. 2022;145(8):2635‐2647. - PubMed
    1. Naudion P, Raffetin A, Zayet S, et al. Positive intrathecal anti‐Borrelia antibody synthesis: what are the implications for clinical practice? Clinical features and outcomes of 138 patients in a French multicenter cohort study. Eur J Clin Microbiol Infect Dis. 2023;42(4):441‐452. - PubMed
    1. Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. d. 2010;17(1):8‐16. - PubMed
    1. Forselv KJN, Lorentzen AR, Ljostad U, et al. Does more favourable handling of the cerebrospinal fluid increase the diagnostic sensitivity of Borrelia burgdorferi sensu lato‐specific PCR in Lyme neuroborreliosis? Infect Dis (Lond). 2018;50(4):297‐302. - PubMed
    1. Leth TA, Nymark A, Knudtzen FC, et al. Detection of Borrelia burgdorferi sensu lato DNA in cerebrospinal fluid samples following pre‐enrichment culture. Ticks and Tick‐Borne Dis. 2023;14(3):102138. - PubMed

MeSH terms

LinkOut - more resources