Background: Lyme disease is endemic in the UK with a high incidence in southwest England. Neurological symptoms are the most common complication. Aim: To review the clinical manifestations and management of Lyme neuroborreliosis in Southwest England. Design and setting: Six hospitals in Hampshire participated in this retrospective, observational study. Methods: Patients with neurological symptoms and a positive screening ELISA followed by confirmatory immunoblots between January 2015 and December 2017 were contacted and a questionnaire completed. Information gathered included demographics, tick exposure, symptoms, sequelae, investigations and treatment. Results: Seventy-two patients were included; 71% initially presented to their GP, 26% were children, a preceding tick bite was reported in 24% and erythema migrans in 36%. The most common symptom was unilateral facial nerve palsy. Central nervous system manifestations were uncommon. Only 13 patients had a lumbar puncture. All patients received effective antibiotics, apart from 2 who were not treated but recovered fully. Treatment duration varied with 55% of patients receiving either a shorter or longer duration than recommended by the EFNS and BIA during the study period. Patients given longer courses did not report fewer sequelae. Complete resolution was reported in 72%. The remainder complained mainly of subjective symptoms. Conclusions: Most patients were diagnosed and managed on clinical grounds and did not undergo invasive investigations. Patients were given effective antibiotics although the difference in duration was marked; recent NICE guidelines recommending 3 weeks of antibiotics may help standardise this. The majority improved with no sequelae. This is the largest UK study focusing exclusively on neuroborreliosis with particular emphasis on management and outcome.
Bibliographical notePublisher Copyright:
- Lumbar puncture
- Lyme neuroborreliosis