Oligoclonal Borrelia burgdorferi-specific IgG antibodies in cerebrospinal fluid in Lyme neuroborreliosis.

Cerebrospinal fluid (CSF) and serum from 45 patients with lymphocytic meningoradiculitis were examined by isoelectric focusing combined with immunoblotting to detect Borrelia burgdorferi-specific oligoclonal immunoglobulin G (IgG) bands. In pretreatment samples, 35 patients (78%) showed B. burgdorferi-specific oligoclonal IgG in CSF indicative of intrathecal antibody production. At 2, 3-6, and 6 weeks after onset, respectively, such bands were present in 5 (42%) of 12, 21 (88%) of 24, and in all of 9 patients (100%). Up to 1 year after therapy, specific oligoclonal bands in CSF tended to remain unchanged despite clinical recovery. B. burgdorferi-specific oligoclonal bands in serum were found in 7 patients. These bands had identical migration patterns as in CSF, but were fewer in number and in some patients showed a temporal evolution different from their CSF counterpart. Not all oligoclonal IgG in CSF reacted with B. burgdorferi. The 41-kDa flagellar antigen was shown to be a major antigen in the intrathecal immune response. The demonstration of B. burgdorferi-specific oligoclonal IgG in CSF is a sensitive and reliable indicator of Lyme neuroborreliosis.