Summary
In 1987, follow-up studies were conducted on 72 patients who had had meningoradiculitis and encephalomyelitis (8 patients) due to Borrelia burgdorferi 5–27 years previously. These patients had not been treated with antibiotics, either during the acute disease or during the interval prior to follow-up studies. The patients had exhibited the typical symptoms of Bannwarth's syndrome during the acute phase. At the follow-up studies, 33 patients showed no, and 23 only mild, clinical residual symptoms including normal CSF findings and low-positive serum IgG borrelia antibody titres (IFT; ELISA). Three patients without sequelae exhibited persistent intrathecal secretion of oligoclonal B. burgdorferi-specific CSF IgG antibodies (Immunoblot; positive borrelia CSF IgG antibody titres). Thirteen patients exhibited mild-to-medium sequelae with persistent intrathecal formation of oligoclonal B. burgdorferi-specific CSF IgG antibodies, up to 21 years after the acute illness. This persistence can be interpreted as an “immunological scar syndrome”. Our follow-up studies appear to indicate that neurological manifestations of B. burgdorferi infections are generally (with few exceptions) of a benign nature. Most patients can be classified as having been cured without antibiotic therapy. No late manifestations of chronic progressive CNS borreliosis comparable to that of neurosyphilis have been seen following acute untreated neuroborreliosis.
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References
Ackermann R (1986) Borrelien-Infektion (Lyme-Krankheit): Was besagt eine positive Serologie? Dtsch Med Wochenschr 111:77–78
Ackermann R (1986) Erythema migrans-Borreliose und Frühsommer-Meningoencephalitis. Dtsch Ärztebl 83:1765–1774
Ackermann R, Hörstrup P, Schmidt R (1984) Tickborne meningopolyneuritis (Garin-Bujadoux-Bannwarth). Yale J Biol Med 57:485–490
Ackermann R, Rehse-Küpper B, Gollmer E (1986) Progressive Borrelia Encephalomyelitits. Zentralbl Bakteriol Mikrobiol Hyg [A] 263:297–300
Bannwarth A (1941) Chronische lymphozytäre Meningitis, entzündliche Polyneuritis und Rheumatismus. Arch Psychiatr Nervenkr 113:284–376
Bannwarth A (1944) Zur Klinik und Pathogenese der „chronischen lymphozytären Meningitis“. Arch Psychiatr Nervenkr 117:161–185
Behringer A, Wirbatz A (1987) Chronische Borrelien-Erkrankung des zentralen Nervensystems. Nervenarzt 58:564–567
Benoit P, Dournou E, Destee A, Warot P (1986) Spirochaetes and Lyme disease. Lancet II:1223
Blake MS, Johnston KH, Russel-Johnes GF, Gotschlich EC (1984) A rapid sensitive method for detection of alkaline phosphatase — conjugated anti-antibody on Western blots. Anal Biochem 136:175–179
Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis J (1982) Lyme disease — a tick-borne spirochetosis? Science 216:1317–1319
Delpech B, Lichtblau E (1972) Étude quantitative des immunoglobulines G et de l'albumine du liquide cephalorachidien. Clin Chim Acta 37:15–23
Diringer MN, Halperin JJ, Dattwyler RJ (1987) Lyme meningoencephalitis: report of a severe, penicillin-resistant case. Arthritis Rheum 30:705–708
Dörries R, Meulen V ter (1984) Detection and identification of virus-specific, oligoclonal IgG in unconcentrated cerebrospinal fluid by immunoblot technique. J Neuroimmunol 7:77–89
Forsberg P, Henriksson A, Link H, Öhman S (1984) Reference values for CSF-IgM, CSF-IgM/S-IgM ratio and IgM index, and its application on patients with multiple sclerosis and aseptic meningoencephalitis. Scand J Clin Lab Invest 44:7–12
Garin C, Bujadoux C (1922) Paralysie par les tiques. J Med Lyon 71:765–767
Hänny PE, Häuselmann HJ (1987) Die Lyme-Krankheit aus der Sicht des Neurologen. Schweiz Med Wochenschr 117:901–915
Hansen K, Rechnitzer C, Pedersen NS, Arpi M, Jessen O (1986) Borrelia meningitis in Denmark. Zentralbl Bakteriol Microbiol Hyg [A] 263:348–350
Henriksson A, Link H (1985) Prolonged IgM response within the central nervous system in lymphocytic meningoradiculitis (Bannwarth's syndrome). N Engl J Med 313:1231
Henriksson A, Link H, Cruz M, Stiernstedt G (1986) Immunoglobulin abnormalities in cerebrospinal fluid and blood over the course of lymphocytic meningoradiculitis (Bannwarth's syndrome). Ann Neurol 20:337–345
Hopf HC (1975) Peripheral neuropathy in acrodermatitis chronica atrophicans (Herxheimer). J Neurol Neurosurg Psychiatry 38:452–458
Kohler J, Kasper J, Kern U, Thoden U, Rehse-Küpper B (1986) Borrelia encephalomyelitis. Lancet II:35
Kohlhepp W, Mertens HG, Oschmann P, Rohrbach E (1987) Akute und chronische Erkrankungen bei zeckenvermittelter Borreliose. Nervenarzt 58:557–563
Kollikowski HH, Schwendemann G, Schulz M, Wilhelm H, Lehmann HJ (1988) Chronic borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy. J Neurol 235:140–142
Krüger H, Englert D, Pflughaupt KW (1981) Demonstration of oligoclonal immunoglobulin G in Guillain Barré syndrome and lymhocytic meningoradiculitis by isoelectric focusing. J Neurol 226:15–24
Krüger H, Reuss K, Reimann G, Pulz M (1988) Follow-up studies with 58 patients having had Lyme-meningoradiculitis and -radiculoencephalomyelitis up to 24 years ago. Abstracts of the First Meeting of the European Neurological Society, June 1988, Nice, France. J Neurol 235 [Suppl]: 16
Laemmli UK (1970) Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 227:680–685
Magnarelli LA, Meegan JM, Anderson JF, Chappell WA (1984) Comparison of an indirect fluorescent-antibody test with an enzymelinked immuno-sorbent assay for serological studies of Lyme disease. J Clin Microbiol 20:181–184
Martin R, Martens U, Sticht-Groh V, Dörries R, Krüger H (1988) Persistent intrathecal secretion of oligoclonal, Borrelia burgdorferi-specific IgG in chronic meningoradiculomyelitis. J Neurol 235:229–233
Midgard R, Hofstad H (1987) Unusual manifestations of nervous system Borrelia burgdorferi infection. Arch Neurol 44:781–783
Murray N, Kristoferitsch W, Stanek G, Steck AJ (1986) Specificity of CSF antibodies against components of Borrelia burgdorferi in patients with meningopolyneuritis Garin-Bujadoux-Bannwarth. J Neurol 233:224–227
Pachner AR, Steere AC (1984) Neurological findings of Lyme disease. Yale J Biol Med 57:481–483
Pachner AR, Steere AC (1985) The triad of neurological manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 35:47–53
Pachner AR, Steere AC (1986) CNS manifestations of third stage Lyme disease. Zentralbl Bakteriol Mikrobiol Hyg [A] 263:301–306
Pfister H-W, Einhäupl KM (1986) Lyme Borreliose — eine durch Borrelia burgdorferi hervorgerufene Multisystemerkrankung. Intern Welt 3:76–84
Pfister H-W, Einhäupl K, Preac-Mursic V, Wilske B (1985) Lyme disease: commentary from Europe. Similarity of neurologic manifestations of Borrelia burgdorferi infections in America and Europe. Neurology 35:1393–1394
Prange HW, Moskophidis M, Schipper HI, Müller F (1983) Relationship between neurological features and intrathecal synthesis of IgG antibodies to Treponema pallidum in untreated and treated human neurosyphilis. J Neurol 230:241–252
Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE (1979) Neurologic abnormalities of Lyme disease. Medicine (Baltimore) 58:281–294
Reik L, Burgdorfer W, Donaldson JO (1986) Neurological abnormalities in Lyme disease without erythema chronicum migrans. Am J Med 81:73–78
Schaltenbrand G (1962) Radikulomyelomeningitis nach Zeckenbiß. Münch Med Wochenschr 104:829–834
Schaltenbrand G (1967) Durch Arthropoden übertragene Erkrankungen der Haut und des Nervensystems. Verh Dtsch Ges Inn Med 72:975–1005
Schaltenbrand G, Müller W (1973) Arboviruserkrankungen des Nervensystems in Europa. Forschungsergebnisse, klinische Beobachtungen und Diskussionsbeiträge auf dem internationalen Symposion in Gießen 1973. Thieme, Stuttgart
Stiernstedt G, Sköldenberg B, Garde A, Kolmodin G, Jörbeck H, Svenungsson B, Carlström A (1986) Clinical manifestations of Borrelia infections of the nervous system. Zentralbl Bakteriol Mikrobiol Hyg [A] 263:289–296
Towbin H, Starhelin T, Gordon J (1979) Electrophoretic transfer of proteins from polyacrylamidgels to nitrocellulose sheets procedere and some applications. Proc Natl Acad Sci USA 76:4350–4354
Vandvik B, Sköldenberg B, Forsgren M, Stiernstedt G, Jeansson S, Norrby E (1985) Long-term persistence of intrathecal virus-specific antibody responses after herpes simplex virus encephalitis. J Neurol 231:307–312
Weder B, Wiedersheim P, Matter L, Steck A, Otto F (1987) Chronic progressive neurological involvement in Borrelia burgdorferi infection. J Neurol 234:40–43
Wilske B, Schierz G, Preac-Mursic V, Busch K, Kühbeck R, Pfister H-W, Einhäupl K (1986) Intrathecal production of specific antibodies against Borrelia burgdorferi in patients with lymphocytic meningoradiculitis (Bannwarth's syndrome). J Infect Dis 153:304–314
Wilske B, Steinhuber R, Bergmeister H, Fingerle V, Schierz G, Preac-Mursic V, Vanek E, Lorbeer B (1987) Lyme-Borreliose in Süddeutschland. Dtsch Med Wochenschr 112:1730–1736
Wokke JHJ, Gijn J van, Elderson A, Stanek G (1987) Chronic forms of Borrelia burgdorferi infection of the nervous system. Neurology 37:1031–1034
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Krüger, H., Reuss, K., Pulz, M. et al. Meningoradiculitis and encephalomyelitis due to Borrelia burgdorferi: a follow-up study of 72 patients over 27 years. J Neurol 236, 322–328 (1989). https://doi.org/10.1007/BF00314373
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DOI: https://doi.org/10.1007/BF00314373