Nervous System Lyme Disease-Facts and Fallacies

The CNS or PNS may be involved in up to 15% of patients with untreated infection with B burgdorferi. The efficacy of antimicrobial therapy (which is curative in the over-whelming majority of patients) in reversing the resulting disorders supports the hy-pothesis that these are caused by direct infection of the nervous system and not by immune or other indirect mechanisms. Neurologic involvement often includes menin-gitis (inflammation of the meninges) and/or multifocal inflammatory changes in periph-eral nerve or rarely, in the brain or spinal cord. PNS involvement most often presents as cranial neuropathy, particularly the facial nerve, or other peripheral mononeuropa-thies. The latter not infrequently presents as quite painful dysfunction of one or several spinal nerve roots, mimicking mechanical radiculopathy. All but the most severely affected patients with neuroborreliosis respond well to oral antimicrobial therapy.