Remaining complaints 1 year after treatment for acute Lyme neuroborreliosis; frequency, pattern and risk factors

• Published in: European journal of neurology Vol. 17; no. 1; pp. 118 - 123
• Main Authors: Ljøstad, U, Mygland, A
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2010; John Wiley & Sons, Inc
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Borrelia; Ceftriaxone - therapeutic use; Chronic Disease - epidemiology; Comorbidity; Complaints; Doxycycline - therapeutic use; Female; follow-up study; Humans; Leukocyte Count - statistics & numerical data; Lyme neuroborreliosis; Lyme Neuroborreliosis - drug therapy; Lyme Neuroborreliosis - epidemiology; Lyme Neuroborreliosis - physiopathology; Male; Middle Aged; Prevalence; prognosis; Prospective Studies; Risk Factors; Sex Distribution; Time; Time Factors
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2009.02756.x

Background and purpose:  To chart remaining complaints 1 year after treatment for neuroborreliosis, and to identify risk factors for a non‐favorable outcome. Methods:  We followed patients treated for neuroborreliosis prospectively, and assessed outcome by a composite clinical score. The impact on outcome of clinical, demographic and laboratory factors were analyzed by univariate analyses and logistic regression. Results:  Out of 85 patients 41 (48%) had remaining complaints; 14 had objective findings and 27 subjective symptoms. Remaining complaints were associated with pre‐treatment symptom duration ≥6 weeks (OR = 4.062, P = 0.044), high pre‐treatment cerebrospinal fluid (CSF) cell count (OR = 1.005, P = 0.001), and female gender (OR = 3.218, P = 0.025). Presence of CSF oligoclonal bands (OCBs) was not analyzed in the logistic regression model due to many missing observations, but was found to be more frequent both pre‐treatment (P = 0.004) and after 12 months (P = 0.015) among patients with remaining complaints as compared to patients with complete recovery. Further evaluation showed that objective remaining findings, and not subjective symptoms, were associated with pre‐treatment symptom duration ≥6 weeks. No difference in outcome was observed between patients treated with IV ceftriaxone and patients treated with oral doxycycline. Conclusion:  Remaining complaints are common after neuroborreliosis. The majority of the complaints are subjective. Pre‐treatment symptom duration ≥6 weeks, high pre‐treatment CSF cell count, and female gender seem to be risk factors for remaining complaints. Presence of CSF OCBs may also predict a non‐favorable outcome, but this should be further studied. Whether subjective and objective complaints are associated with different risk factors is also an issue for future studies.