EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis

  1. Å. Mygland1,2,3,
  2. U. Ljøstad1,
  3. V. Fingerle4,
  4. T. Rupprecht5,
  5. E. Schmutzhard6,
  6. I. Steiner7

Article first published online: 23 NOV 2009

DOI: 10.1111/j.1468-1331.2009.02862.x

Issue

European Journal of Neurology

European Journal of Neurology

Volume 17, Issue 1, pages 8–e4, January 2010

Additional Information

How to Cite

Mygland, Å., Ljøstad, U., Fingerle, V., Rupprecht, T., Schmutzhard, E. and Steiner, I. (2010), EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. European Journal of Neurology, 17: 8–e4. doi: 10.1111/j.1468-1331.2009.02862.x

Author Information

  1. 1

    Department of Neurology

  2. 2

    Department of Rehabilitation, Sørlandet Sykehus, Kristiansand

  3. 3

    Department of Clinical Medicine, University of Bergen, Bergen, Norway

  4. 4

    Bavarian Health and Food Safety Authority, Oberschleißheim

  5. 5

    Department of Neurology, Ludwig-Maximilians University, Munich, Germany

  6. 6

    Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

  7. 7

    Neurological Sciences Unit, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel

*Å. Mygland, Department of Neurology, Sørlandet Sykehus, Serviceboks416, N-4604 Kristiansand S, Norway (tel.: +47 380 73914; fax: +47 380 73911; e-mail: aase.mygland@sshf.no).

  1. This is a Continuing Medical Education article, and can be found with corresponding questions on the Internet at http://www.efns.org/EFNSContinuing-Medical-Education-online.301.0.html. Certificates for correctly answering the questions will be issued by the EFNS.

Publication History

  1. Issue published online: 18 DEC 2009
  2. Article first published online: 23 NOV 2009
  3. Received 7 August 2009 Accepted 2 October 2009

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Keywords:

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

Background:  Lyme neuroborreliosis (LNB) is a nervous system infection caused by 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 of them for possible LNB: (i) neurological symptoms; (ii) cerebrospinal fluid (CSF) pleocytosis; (iii) Bb-specific antibodies produced intrathecally. PCR and CSF culture may be corroborative if symptom duration is <6 weeks, when Bb antibodies may be absent. PCR is otherwise not recommended. There is also not enough evidence to recommend the following tests for diagnostic purposes: microscope-based assays, chemokine CXCL13, antigen detection, immune complexes, lymphocyte transformation test, cyst formation, 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, except that doxycycline is contraindicated under 8 years of age (nine 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).

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