12. Diagnosis and Management of European Lyme Neuroborreliosis

  1. Nils Erik Gilhus MD, PHD7,8,
  2. Michael P. Barnes MD, FRCP9,10 and
  3. Michael Brainin MD11,12,13
  1. Åse Mygland1,2,
  2. Unn Ljøstad1,
  3. Volker Fingerle3,
  4. Tobias Rupprecht4,
  5. Erich Schmutzhard5 and
  6. Israel Steiner6

Published Online: 21 SEP 2011

DOI: 10.1002/9781444346268.ch12

European Handbook of Neurological Management, Volume 2, Second Edition

European Handbook of Neurological Management, Volume 2, Second Edition

How to Cite

Mygland, Å., Ljøstad, U., Fingerle, V., Rupprecht, T., Schmutzhard, E. and Steiner, I. (2011) Diagnosis and Management of European Lyme Neuroborreliosis, in European Handbook of Neurological Management, Volume 2, Second Edition (eds N. E. Gilhus, M. P. Barnes and M. Brainin), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346268.ch12

Editor Information

  1. 7

    Department of Clinical Medicine, University of Bergen, Norway

  2. 8

    Department of Neurology, Haukeland University Hospital, Bergen, Norway

  3. 9

    University of Newcastle, Newcastle upon Tyne, UK

  4. 10

    Hunters Moor Neurorehabilitation Ltd, Newcastle upon Tyne, UK

  5. 11

    Department of Clinical Medicine and Prevention, Austria

  6. 12

    Center for Clinical Neurosciences, Donau-Universität Krems, Austria

  7. 13

    Department of Neurology, Landesklinikum Donauregion Tulln, Tulln, Austria

Author Information

  1. 1

    Sørlandet Sykehus, Kristiansand, Norway

  2. 2

    University of Bergen, Bergen, Norway

  3. 3

    Bavarian Health and Food Safety Authority, Oberschleißheim, Germany

  4. 4

    Ludwig-Maximilians University, Munich, Germany

  5. 5

    Medical University Innsbruck, Austria

  6. 6

    Hadassah University Hospital, Mount Scopus, Jerusalem, Israel

Publication History

  1. Published Online: 21 SEP 2011
  2. Published Print: 30 SEP 2011

ISBN Information

Print ISBN: 9781405185349

Online ISBN: 9781444346268



  • antibiotic therapy;
  • Bannwarth syndrome;
  • European;
  • infections;
  • Lyme neuroborreliosis


Background: Lyme neuroborreliosis (LNB) is a nervous system infection due to Borrelia burgdorferi sensu lato (Bb).

Objectives: To present evidence-based recommendations for diagnosis and treatment.

Methods: Data were analysed according to levels of evidence as suggested by EFNS.

Recommendations: The following three criteria should be fulfilled for definite LNB, and two for possible LNB: (1) neurological symptoms; (2) CSF pleocytosis; (3) Bb specific antibodies produced intathecally. PCR and CSF culture may be corroborative if symptom duration is less than 6 weeks, when Bb antibodies may be absent. PCR is otherwise not recommended. There is insufficient evidence to recommend the following tests for diagnostic purposes: microscope-based assays, chemokine CXCL13, antigen detection, immune complexes, lymphocyte transformation test, cyst formation and lymphocyte markers.

Adult patients with definite or possible acute LNB (symptom duration < 6 months) should be offered a single, 14-day course of antibiotic treatment. Oral doxycycline (200 mg daily) and intravenous (IV) ceftriaxone (2 g daily) are equally effective in patients with symptoms confined to the peripheral nervous system, including meningitis (Level A). Patients with CNS manifestations should be treated with IV ceftriaxone (2 g daily) for 14 days, and late LNB (symptom duration > 6 months) for 3 weeks (good practice points). Children should be treated as adults, however doxycycline is contraindicated in children under 8 years of age (9 years in some countries). If symptoms persist for more than 6 months after standard treatment, the condition is often termed post-Lyme disease syndrome (PLDS). Antibiotic therapy has no impact on PLDS (Level A).