Immunological differentiation between neuroborreliosis and multiple sclerosis

Abstract

Neuroborreliosis, a tick-borne spirochaetosis of the central nervous system, is diagnosed by the presence of intrathecally synthesized Borrelia burgdorferi-specific antibodies. Multiple sclerosis and neuroborreliosis can show similarities in clinical symptoms as well as lymphocytic cell reactions and oligoclonal bands in the isoelectric focusing of cerebrospinal fluid. To differentiate between multiple sclerosis and neuroborreliosis we tested intrathecally synthesized IgM and virus antibodies. The IgM indices were higher for most of the neuroborreliosis patients studied than for those with multiple sclerosis, and cell counts were also significantly higher in the acute stage of the disease. In 84% of multiple sclerosis patients we were able to demonstrate intrathecal antibody production against measles, rubella or mumps virus. Neuroborreliosis patients had no intrathecal virus antibody synthesis. The specification of oligoclonal bands resulting from isoelectric focusing of cerebrospinal fluid with an ELISA for B. burgdorferi can further substantiate the diagnosis of neuroborreliosis or help to rule it out in multiple sclerosis patients with positive borrelia-specific serology.

CSF isoelectrofocusing in a large cohort of MS and other neurological diseases

“…In our study, 50 patients in the OND group (8%) presented OCB (Table 3). Our results are in accordance with those of previous studies showing that OCB may occur in Lyme disease (Heller et al, 1990), human immunodeficiency virus (HIV) encephalitis (Lambin et al, 1991), paraneoplastic syndromes or lymphoma (Zenone, 1992;Rauer and Kaiser, 2000). However, these pathologies are clinically different from MS. With regard to infectious disorders, the clinical context and the cell count should also help in differential diagnosis.…”

Serological differences in monozygotic twin pairs discordant for multiple sclerosis

“…It has been discussed how to distinguish between Borrelia infections and MS since there are some similarities in symptoms and spinal fluid reactions. However, the disease caused by persistent Borrelia is distinct from MS (6,7). Only a small fraction of the MS patients have antibodies against B. burgdorferi and antibiotic treatment against Borrelia has no effect on subsequent MS‐relapses (8).…”

A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

“…Though oligoclonal bands were present on CSF analysis as well, it has been well established that this is an expected finding in LNB. 6 The patient had a negative CSF myelin basic protein level, which is a relatively specific marker for MS. 7 Additionally, the CSF measles/mumps antibody titer was not elevated, which is a reliable indicator of differentiating LNB from MS. 8 , 9 In our case CSF Lyme DNA PCR was negative, which is a common finding in chronic neuroborreliosis; detection by PCR or CSF culture occurs in only 10-30% of patients. 2 , 10 Furthermore, radiologic findings in this patient are not typical of MS lesions.…”