Most children recover from Lyme neuroborreliosis

By Will Boggs, MD

NEW YORK (Reuters Health) - Clinical recovery is usually satisfactory in children treated for Lyme neuroborreliosis - infection of the nervous system that usually occurs in the late stages — and subsequent fatigue or headache are not attributable to the condition, according to a report in The Pediatric Infectious Disease Journal.

Antibiotic treatment is effective and long-term side effects of the disease are rare, Dr. Barbro Hedin Skogman from the Center for Clinical Research Dalarna, Falun, Sweden, told Reuters Health. “Nonspecific symptoms are not due to neuroborreliosis.”

Hedin Skogman and colleagues studied 177 children being evaluated for Lyme neuroborreliosis in an area in Sweden in which the disease is prevalent, to investigate their clinical outcomes and to identify factors of importance for recovery.

The patients were classified as having confirmed neuroborreliosis, possible neuroborreliosis, or “not determined.” They were followed for 6 months and compared with a matched control group of 174 children with Lyme disease.

Symptoms that occurred more often in the confirmed neuroborreliosis group than in the “not determined” group included fatigue, facial nerve palsy, loss of appetite, and fever, the authors report.

Patients with confirmed neuroborreliosis were more likely to have irregularities in the cerebrospinal but laboratory results were abnormal in all patients.

Antibiotic treatment was given to 69 percent of the children. At 2 months, 117 patients had recovered completely, and by 6 months 140 had recovered. No patient reported progressive or reoccurring neurological symptoms.

The only significant persistent symptom at follow-up that occurred only among confirmed patients was facial nerve palsy, which persisted in 11 patients (6 percent) at the 6-month follow-up.

None of the variables investigated correlated with disease course among confirmed patients or among patients who received antibiotic treatment.

“Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls,” the investigators found.

Hedin Skogman added that “a 5-year follow-up with neurological and otoneurological examination as well as reported symptoms” is planned.

SOURCE: The Pediatric Infectious Disease Journal, December 2008.

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