Meningoradiculitis and encephalomyelitis due to Borrelia burgdorferi: a follow-up study of 72 patients over 27 years

Abstract

In 1987, follow-up studies were conducted on 72 patients who had had meningoradiculitis and encephalomyelitis (8 patients) due to Borrelia burgdorferi 5-27 years previously. These patients had not been treated with antibiotics, either during the acute disease or during the interval prior to follow-up studies. The patients had exhibited the typical symptoms of Bannwarth's syndrome during the acute phase. At the follow-up studies, 33 patients showed no, and 23 only mild, clinical residual symptoms including normal CSF findings and low-positive serum IgG borrelia antibody titres (IFT; ELISA). Three patients without sequelae exhibited persistent intrathecal secretion of oligoclonal B. burgdorferi-specific CSF IgG antibodies (Immunoblot; positive borrelia CSF IgG antibody titres). Thirteen patients exhibited mild-to-medium sequelae with persistent intrathecal formation of oligoclonal B. burgdorferi-specific CSF IgG antibodies, up to 21 years after the acute illness. This persistence can be interpreted as an "immunological scar syndrome". Our follow-up studies appear to indicate that neurological manifestations of B. burgdorferi infections are generally (with few exceptions) of a benign nature. Most patients can be classified as having been cured without antibiotic therapy. No late manifestations of chronic progressive CNS borreliosis comparable to that of neurosyphilis have been seen following acute untreated neuroborreliosis.

Diagnosis of Lyme neuroborreliosis with antibodies to recombinant proteins DbpA, BBK32, and OspC, and VlsE IR 6 peptide

“…Intrathecal production of antibodies to Borrelia appears to be more frequent in Europe than in the USA [6,39]. In convalescence, specific antibodies may persist in the CSF, regardless of the clinical symptoms [10,22].…”

Screening for neuroborreliosis in patients with stroke.

“…", [3][4][5][6] The clinical manifestations of Lyme neuroborreliosis are usually meningitis, meningoradiculitis, or cranial neuritis.5-8 The frequency of recovery from neuroborreliosis is high even in patients not treated with antibiotics. 9 In rare instances, however, neurological symptoms may progress in untreated cases, causing encephalomyelitis with symptoms like paraparesis, hemiparesis, dysphasia, and ataxia.78 '10-12 The possibility that our patient with dysphasia suffered from two different diseases, Lyme neuroborreliosis and TIA due to arteriosclerosis, is unlikely because she had a typical medical history of ongoing chronic Lyme neuroborreliosis and CSF findings of chronic meningitis soon after developing strokelike symptoms. She also responded promptly to antibiotic therapy and developed no further symptoms of stroke posttreatment.…”

Nervous System Lyme Borreliosis

“…In individuals with more longstanding neuroborreliosis, CSF normalizes more slowly (Kaiser, 1994), and the amount of intrathecally produced immunoglobulin does not necessarily decline during the initial period after treatment (Hammers Berggren et al, 1993). CSF IgG oligoclonal bands can still be demonstrated in one-third of patients 5 to 17 years after infection (Kr€ uger et al, 1989). Other reported CSF biochemical markers of disease activity include elevated concentrations of astroglial protein GFAp (Dotevall et al, 1996), IL-2, IL-6, fibronectin (Weller et al, 1991), neopterin (Dotevall et al, 1990), and metalloproteinase with recent evidence that glia play a prominent role in this response (Ramesh et al, 2009).…”

“…Persistent live spirochetes in the CNS have never been demonstrated, and seem unlikely since there are no verified late relapses in neuroborreliosis (Kr€ uger et al, 1989). Thus the term "chronic" neuroborreliosis is misleading and should be avoided (Feder et al, 2007).…”

“…The duration of persistent symptoms in patients with neuroborreliosis if antibiotic treatment is not given has been estimated to be three to six months in most cases (Kr€ uger et al, 1990), although in some patients continuing and progressive infection may occur (Bensch et al, 1987). In a long-term follow-up study of adult patients many years after untreated neuroborreliosis, Kr€ uger et al observed that 18% of the patients exhibited "mild to medium sequelae" up to 21 years after acute illness, while 32% had mild clinical sequelae (Kr€ uger et al, 1989). Again, the significance of this observation is unclear in the absence of information about the incidence of such symptoms in uninfected control populations.…”