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Peripheral nervous system Lyme borreliosis
1Harvard Medical School, Clinical Neurophysiology Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Seminars in Neurology
|March 1, 1997
Summary
Acute and chronic Lyme neuropathies present distinct diagnostic challenges. Electrophysiologic testing aids in identifying sensorimotor polyradiculoneuropathy, with intravenous ceftriaxone showing treatment efficacy.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Lyme disease can manifest as acute or chronic neuropathies, including cranial neuritis and radiculoneuritis.
- Diagnosis can be challenging due to variable presentations and absence of classic erythema migrans.
Observation:
- Acute and chronic Lyme radiculoneuropathies share pathologic features, classified as nonvasculitic mononeuritis multiplex.
- Electrophysiologic testing frequently confirms a sensorimotor, axon loss polyradiculoneuropathy in both forms.
Findings:
- The pathogenesis of Lyme neuropathies remains uncertain, with potential roles for direct infection or parainfectious mechanisms.
- Intravenous ceftriaxone (2 g/day for 2-4 weeks) is an experienced treatment, showing rapid improvement in acute cases and slower recovery in chronic cases.
Implications:
- Accurate diagnosis of Lyme neuropathies relies on clinical history, laboratory testing, and electrophysiologic findings.
- Understanding the pathogenesis and treatment response is crucial for managing Lyme disease neurological complications.