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Remaining complaints 1 year after treatment for acute Lyme neuroborreliosis; frequency, pattern and risk factors

Authors

  • U. Ljøstad,

    1. Department of Neurology, Sørlandet Hospital HF, Kristiansand, Norway
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  • Å. Mygland

    1. Department of Neurology, Sørlandet Hospital HF, Kristiansand, Norway
    2. Hospital for Rehabilitation, Rikshospitalet University Hospital, Kristiansand, Norway
    3. Institute of Clinical Medicine, University of Bergen, Bergen, Norway
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U. Ljøstad, Department of Neurology, Sørlandet Hospital HF, Kristiansand, Serviceboks 416, N-4604 Kristiansand, Norway (tel.: +4738073910; fax: +4738073911; e-mail: unn.ljostad@sshf.no; aase.mygland@sshf.no).

Abstract

Background and purpose:  To chart remaining complaints 1 year after treatment for neuroborreliosis, and to identify risk factors for a non-favorable outcome.

Methods:  We followed patients treated for neuroborreliosis prospectively, and assessed outcome by a composite clinical score. The impact on outcome of clinical, demographic and laboratory factors were analyzed by univariate analyses and logistic regression.

Results:  Out of 85 patients 41 (48%) had remaining complaints; 14 had objective findings and 27 subjective symptoms. Remaining complaints were associated with pre-treatment symptom duration ≥6 weeks (OR = 4.062, = 0.044), high pre-treatment cerebrospinal fluid (CSF) cell count (OR = 1.005, = 0.001), and female gender (OR = 3.218, = 0.025). Presence of CSF oligoclonal bands (OCBs) was not analyzed in the logistic regression model due to many missing observations, but was found to be more frequent both pre-treatment (= 0.004) and after 12 months (= 0.015) among patients with remaining complaints as compared to patients with complete recovery. Further evaluation showed that objective remaining findings, and not subjective symptoms, were associated with pre-treatment symptom duration ≥6 weeks.

No difference in outcome was observed between patients treated with IV ceftriaxone and patients treated with oral doxycycline.

Conclusion:  Remaining complaints are common after neuroborreliosis. The majority of the complaints are subjective. Pre-treatment symptom duration ≥6 weeks, high pre-treatment CSF cell count, and female gender seem to be risk factors for remaining complaints. Presence of CSF OCBs may also predict a non-favorable outcome, but this should be further studied. Whether subjective and objective complaints are associated with different risk factors is also an issue for future studies.

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