Neuroborreliosis (Lyme disease)
Lyme disease is caused by an infection with the Borrelia bacterium and is transmitted by ticks. Not all ticks are infected with the bacterium (estimated 10 to 30% of the ticks in the Netherlands) and even after a tick bite by an infected tick persons often do not develop the disease. The classic sign of early local infection is a circular red rash on the site of the tick bite that is expanding outwardly (erythema migrans). This red rash can however also be absent even though there is an infection.
The Borrelia bacterium can spread to the bloodstream and can give various manifestations. Often skin and joints are involved, but sometimes neurological problems occur. If the Borrelia bacterium has infected the nervous system, one speaks of neuroborreliosis. Borrelia infection of the nervous system can give various symptoms, but the common presentations include facial palsy, meningitis or shooting pains in an arm or leg due to radiculoneuritis.
The diagnosis neuroborreliosis can be confirmed if Borrelia antibodies (antibodies made by the immune system against Borrelia bacterium) are be measured in blood and cerebrospinal fluid. Those antibodies can be absent in the first weeks after infection, but in a later stage of Lyme disease the test are considered to be reliable. If blood test point out a Borrelia infection and neurological complaints are present, a lumbar puncture is indicated to investigate if neuroborreliosis exists. In case of neuroborreliosis, inflammatory cells, a high amount of protein and antibodies against Borrelia are seen in the cerebrospinal fluid.
Treatment of neuroborreliosis consists of intravenously administered antibiotics. More information about the diagnosis and treatment of Lyme disease can be found in the brochures of the AMC Lyme center: