• Lyme neuroborreliosis;
  • diagnosis;
  • antibodies;
  • sensitivity;
  • specificity;
  • Borrelia burgdorferi

Objectives –  To survey present knowledge and controversies in European neuroborreliosis.

Material and methods –  The article is based on available literature, own experience, and a speech held by the authors together on the Norwegian annual neurological meeting.

Results –  Diagnosis of neuroborreliosis is based on clinical neurological findings, laboratory support of borrelia infection, and indications of causality between neurological findings and borreliosis. In the absence of means to identify B. burgdorferi, antibody tests are used for laboratory diagnosis. Two to three weeks courses of IV penicillin or ceftriaxone are highly effective in neuroborreliosis. Oral doxycyclin is probably equally effective. Remaining symptoms five years after treatment for neuroborreliosis are reported in 25–50% of patients.

Conclusions –  We suggest two levels of diagnostic accuracy; definite and possible neuroborreliosis. These case definitions are proposed to make the basis for treatment decisions. The prognosis of neuroborreliosis and pathophysiology of post-treatment conditions need further studies. Extensive treatments with antibiotics are not recommended.