Lyme disease: a multisystem infection that affects the nervous system.

PURPOSE OF REVIEW: This article will enable the reader to diagnose and treat nervous system Lyme disease appropriately.

RECENT FINDINGS: Appropriately applied serologic testing has high positive and negative predictive values in nervous system Lyme disease. Oral antibiotics can be curative in most cases.

SUMMARY: Infection with the tick-transmitted spirochete Borrelia burgdorferi causes Lyme disease, a disorder that involves the nervous system in about 15% of patients. Common manifestations include lymphocytic meningitis, cranial neuritis (particularly cranial nerve VII), painful radiculitis, other forms of mononeuropathy multiplex, and rarely CNS parenchymal involvement. Diagnosis is supported primarily by demonstration of anti-B. burgdorferi antibodies in serum. CSF examination can be informative in problematic cases with parenchymal CNS infection or to identify meningitis. However, oral antibiotics are probably effective in patients with meningitis and other forms of involvement, with the likely exception of parenchymal CNS infection.