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Oral doxycycline for Lyme neuroborreliosis with symptoms of encephalitis, myelitis, vasculitis or intracranial hypertension.

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The treatment recommendation for
Lyme neuroborreliosis with central nervous system (CNS) symptoms is intravenous ceftriaxone, according to current American and European guidelines. For
Lyme neuroborreliosis with peripheral nervous system (PNS) symptoms, treatment with intravenous ceftriaxone and oral doxycycline is considered equally effective. The purpose of this study was to evaluate the efficacy of oral doxycycline in the treatment of
Lyme neuroborreliosis with CNS symptoms.


Patients with
Lyme neuroborreliosis who had undergone cerebrospinal fluid (CSF) sampling before and after treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, during the period 1990-2012, were included in this retrospective study. The CSF mononuclear cell count was used as a surrogate marker of treatment outcome. Comparisons of CSF mononuclear cell counts were made between patients with CNS symptoms and patients with PNS symptoms before and after treatment with oral doxycycline.


Twenty-six patients classified as having CNS symptoms and 115 patients classified as having PNS symptoms were included. The decline in CSF mononuclear cell counts did not differ significantly between the two groups of patients. All patients with CNS
disease showed a marked clinical improvement after treatment, even though 62% had remaining symptoms at the end of follow-up.


Treatment with oral doxycycline resulted in a similar decrease in CSF mononuclear cell counts in patients with
Lyme neuroborreliosis with CNS symptoms compared with patients with
Lyme neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for
Lyme neuroborreliosis irrespective of the severity of symptoms.

© 2014 The Author(s) European Journal of Neurology © 2014 EAN.

Eur J Neurol. 2014 Sep;21(9):1162-7. doi: 10.1111/ene.12420. Epub 2014 Mar 29. Research Support, Non-U.S. Gov’t

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