R F López-Alberola1. 1. Section of Child Neurology, University of Miami School of Medicine, Miami, Florida 33136, USA. rlopez@med.miami.edu
Abstract
AIMS: To review the medical literature on neuroborreliosis, in particular its clinical features in both adults and children, and highlight the differences between the two groups, with an emphasis on the pediatric population. DEVELOPMENT: The neurologic manifestations of the disease variably affect different areas of the neuroaxis, central or peripheral, and can present with early or late symptomatology, depending on the age group. Although the literature includes a wide range of neurologic abnormalities, the most frequent symptom reported in the pediatric population is headache, and the most common sign being facial palsy. An immunologic process with cross-reacting antibodies and antibodies directed against neuronal proteins may exist as the causative factor. Because of characteristic cerebrospinal fluid (CSF) findings, CSF examination and serologic testing for Borrelia burgdorferi, the causative agent, should be performed in patients, particularly if a child, having been in an endemic area, presenting with an acute neurologic disorder of unexplained etiology. Treatment with antibiotics, if initiated early-on, is curative, especially in children. CONCLUSIONS: The pediatric population carries the highest risk for Lyme disease relative to other age groups. Younger patients tend to be more acutely affected, with involvement primarily of the central nervous system, exhibiting an inflammatory response in the CSF and signs/symptoms of aseptic meningitis and facial nerve palsy, whereas older patients present with features of peripheral nervous system pathology, tipically with a radiculopathy. Despite having a greater incidence of neuroborreliosis, the clinical course in most children is milder and shorter than that reported for adults.
AIMS: To review the medical literature on neuroborreliosis, in particular its clinical features in both adults and children, and highlight the differences between the two groups, with an emphasis on the pediatric population. DEVELOPMENT: The neurologic manifestations of the disease variably affect different areas of the neuroaxis, central or peripheral, and can present with early or late symptomatology, depending on the age group. Although the literature includes a wide range of neurologic abnormalities, the most frequent symptom reported in the pediatric population is headache, and the most common sign being facial palsy. An immunologic process with cross-reacting antibodies and antibodies directed against neuronal proteins may exist as the causative factor. Because of characteristic cerebrospinal fluid (CSF) findings, CSF examination and serologic testing for Borrelia burgdorferi, the causative agent, should be performed in patients, particularly if a child, having been in an endemic area, presenting with an acute neurologic disorder of unexplained etiology. Treatment with antibiotics, if initiated early-on, is curative, especially in children. CONCLUSIONS: The pediatric population carries the highest risk for Lyme disease relative to other age groups. Younger patients tend to be more acutely affected, with involvement primarily of the central nervous system, exhibiting an inflammatory response in the CSF and signs/symptoms of aseptic meningitis and facial nerve palsy, whereas older patients present with features of peripheral nervous system pathology, tipically with a radiculopathy. Despite having a greater incidence of neuroborreliosis, the clinical course in most children is milder and shorter than that reported for adults.