Neuroborreliosis

Neuroborreliosis (neuro - borreliosis) is a manifestation of Lyme disease, an infectious disease that is caused by the bacterium Borrelia burgdorferi. This pathogen is transmitted mainly by the Commons tick (Ixodes ricinus) in Europe, very rare even by flying insects ( horseflies, mosquitoes ). Lyme disease is a systemic disease that can affect various organ systems, among other things, it also affects the central and peripheral nervous system. A neuroborreliosis is about 50 % after the erythema migrans is the most common disease manifestation of Borrelia infection in Europe and also in Germany.

Course

In the initial stage (early localized stage ) of the Lyme disease infection occurs between the 3rd and the 30th day after a tick bite in about half of patients an annular redness (erythema chronicum migrans ), often at the site of the tick bite on. Atypical forms as a lymphocytoma are possible, other symptoms of infection may be flu-like symptoms such as headache, feeling of exhaustion, and increased temperature. If the erythema migrans is treated dosed not timely or not long and high enough with antibiotics, there is a risk that the pathogen spread ( disseminated or generalized stage). The incidence of flu-like symptoms, particularly fever, fatigue, muscle aches (myalgia ), but without cough and runny nose, indicates a transition in the disseminated stage.

Since the tick bite is usually painless, no erythema migrans developed at about 50 percent of sufferers and this is often overlooked in occurrence poorly visible parts of the body, the disease can continue to progress and all organs, but especially the central and peripheral nervous system, muscles and joints as well as the heart afflicted. Often the neuroborreliosis developed in the early disseminated stage. You can also coincided with a erythema migrans occur. Due to possible prolonged incubation and latency periods, the disease manifestations can develop in some cases years after a successful infection until months or even.

Signs of disease

In the early disseminated stage often occurs meningitis and meningoradiculitis ( Garin - Boujadoux ) Bannwarth. Typical are especially at night severe pain in the area supplied by individual nerves or nerve roots, often with accompanying paralysis. There may be cranial nerve failures, furnished an example is the often -sided Peripheral facial palsy. An isolated involvement of the peripheral nervous system, allowing an inflammation of nerves ( neuritis ) is possible.

In the European and German recommendations for Lyme disease following late forms of neuroborreliosis are:

• Neurological, neuropsychiatric disorders
• Radiculitis spinal nerves and cranial nerves,
• Neuritis of peripheral nerves,
• Meningitis,
• Myelitis,
• Cerebral vasculitis,
• Myositis, dermatomyositisartige gradients,
• Encephalitis, encephalopathy.

For the following signs of illness should be thought of neuroborreliosis:

• Strong nerve pain that does not respond to pain medication or the usual anti-inflammatory painkillers ( NSAIDs),
• Paralysis, especially on the legs and face
• Numbness in the face and / or extremities
• Heat and cold feeling or chills
• Strong lasting cap-shaped headache
• Dizziness and balance disorders
• Vision changes (eg, optic neuritis )
• Gait disturbance ( staksiger gear)
• Cognitive impairments, such as concentration, memory, word finding difficulties
• Persistent and severe malaise and fatigue
• Personality changes

The early acute neuroborreliosis is usually associated with very severe disease symptoms. The later course can be insidious.

Diagnostics

The diagnosis of neuroborreliosis is often difficult. You can ultimately only be secured due to a cerebrospinal fluid examination. The following diagnostic criteria are given in the literature for the diagnosis of neuroborreliosis:

• An appropriate clinical picture,
• The presence of intrathecally produced antibodies ( Liquor-/Serum-Index, IgG and IgM occurred > 2.0 ( or 1.5 ) to ensure that the antibodies are not transferred passively from the serum, but antibody production in CSF is )
• A proliferation of certain white blood cells in the cerebrospinal fluid ( lymphocytic pleocytosis )
• As a possible additional criteria determining the albumin quotient for the detection of blood-CSF barrier dysfunction and specific oligoclonal bands.

Depending on which criteria are met, the neuroborreliosis is as assured, referred probable or possible. The rating of the diagnostic criteria, however, is debatable. Thus, signs of inflammation in the CSF, especially lacking in cases of infestation of the peripheral nervous system. In the early phase of neuroborreliosis with involvement of the central nervous system are often no antibodies and therefore no intrathecal antibody in CSF to be found.

Therapy

There penicillins, cephalosporins ( ceftriaxone, cefotaxime ) or doxycycline are used. Usually three to four weeks is treated with antibiotics with them. The optimal treatment of neuroborreliosis is however debatable. In a recent American study it was investigated whether the Lyme encephalopathy on a new and longer administered treatment responds with ceftriaxone. There were only found short-term improvements. Medical disagreement concerning the nature of the antibiotic, the duration of treatment, the dosage of the respective antibiotic side effects and potential duplication of therapy failure.