Lyme disease should be suspected in any patient with chronic lymphocytic meningitis or mild meningoencephalitis with associated cranial neuritis or radiculitis. Lab tests include serologic assays like immunofluorescent assay and enzyme-linked immunoassay tests for anti–B. burgdorferi antibodies. Specific anti–B. burgdorferi antibody also appears in CSF, where it can be detected even when serum antibody tests are negative. (To establish whether these antibodies are synthesized intrathecally, serum and CSF antibody levels should be measured simultaneously.28)
The CSF profile in Lyme disease encephalomeningitis includes these findings:
Following are diagnostic criteria for Lyme neuroborreliosis:
|Possible neuroborreliosis||Compatible neurologic abnormality |
and history of tick bite or travel or
residence in endemic area
|Probable neuroborreliosis||Compatible neurologic abnormality |
and serum immunoreactivity to B. burgdorferi
|Definite neuroborreliosis||Compatible neurologic abnormality
plus one of the following: |
In most patients with late Lyme disease (especially those with cortical dysfunction, but also many without), the EEG demonstrates nonspecific generalized slowing, focal slowing, increases in sharp wave activity, or a combination of these.13
Reviewed and revised March 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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