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EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.

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Abstract

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) 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).

Eur J Neurol. 2010 Jan;17(1):8-16, e1-4. doi: 10.1111/j.1468-1331.2009.02862.x. Epub 2009 Nov 23. Practice Guideline

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