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Nervous System Lyme Disease

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Neurorheumatology

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Abstract

Lyme disease, and the closely related disorders described in Europe, affects the nervous system in about 10–15% of infected individuals (Koedel U, Fingerle V, Pfister HW. Lyme neuroborreliosis-epidemiology, diagnosis and management. Nat Rev Neurol. 2015;11(8):446–56). Clinically it is manifest as a variably symptomatic lymphocytic meningitis, multifocal inflammation of peripheral nerves (common), and focal or multifocal inflammation of the CNS (very rare). In children it is important to recognize that meningitis can cause a pseudo-tumor-like disorder; in adults, painful radiculopathy is under-recognized. CNS infection is almost always accompanied by a CSF pleocytosis; this is not necessarily found if only the PNS is involved. Measurement of intrathecal antibody production is useful in patients with otherwise evident CNS inflammation. Antimicrobial therapy is highly effective in virtually all patients. The entity referred to as Lyme encephalopathy is not due to CNS infection or inflammation. The entity referred to as PTLDS may or may not exist as a distinct disorder, but is clearly not related to neuroborreliosis. If it is causally related to Lyme disease at all it occurs in only a very small subset of treated patients.

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Authors and Affiliations

  1. Department of Neurosciences, Overlook Medical Center, Summit, NJ, USA

    John J. Halperin

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  1. John J. Halperin
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Correspondence to John J. Halperin .

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Editors and Affiliations

  1. Division of Neuroimmunology, University of Iowa, Iowa City, IA, USA

    Tracey A. Cho

  2. Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Shamik Bhattacharyya

  3. Division of Rheumatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Simon Helfgott

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Halperin, J.J. (2019). Nervous System Lyme Disease. In: Cho, T., Bhattacharyya, S., Helfgott, S. (eds) Neurorheumatology. Springer, Cham. https://doi.org/10.1007/978-3-030-16928-2_26

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  • DOI: https://doi.org/10.1007/978-3-030-16928-2_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16927-5

  • Online ISBN: 978-3-030-16928-2

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