A retrospective observational study of Lyme neuroborreliosis in the southwest of England

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.