Kaminsky Anne-Laure, Maisonobe Thierry, Lenglet Timothée, Psimaras Dimitri, Debs Rabab, Viala Karine
Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy.
Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Medicine (Baltimore). 2020 Oct 2;99(40):e21986. doi: 10.1097/MD.0000000000021986.
The manifestations of borreliosis in the peripheral nervous system (PNS) remain poorly described. As the symptoms of neuroborreliosis can be reversed with timely introduction of antibiotics, early identification could avoid unnecessary axonal loss. Our aim was to describe the characteristics of confirmed neuroborreliosis cases involving the PNS diagnosed between 2007 and 2017 in our neuromuscular disease center in a nonendemic area (La Pitié-Salpêtrière Hospital, Paris, France).Neuroborreliosis was defined as follows: compatible neurological symptoms without other cause of neuropathy; cerebrospinal fluid and serum analysis (positive serological tests with ELISA, confirmed by Western Blot); and improvement of symptoms with adapted antibiotherapy. All the patients consulting in our center between 2007 and 2017 underwent electrophysiological study.Sixteen confirmed cases of neuroborreliosis involving the PNS were included: 10 cases of meningoradiculoneuritis, 4 of axonal neuropathy, and 2 of demyelinating neuropathy (one acute and one chronic). Only 4 (25%) patients reported tick bites. Meningoradiculoneuritis was characterized by lymphocytic meningitis, intense pain, cranial nerve palsy, and contrast enhancement of nerve roots on imagery. The patients with axonal neuropathy presented sensory symptoms with intense pain but no motor deficit and meningitis was rare. Nerve biopsy of 1 patient revealed lymphocytic vasculitis. Electrophysiological testing showed sensory or sensorimotor axonal neuropathy (3 subacute and 1 chronic) of the lower limbs, with asymmetrical neuropathy in 1 patients, symmetrical neuropathy in one and monomelic sensory mononeuritis multiplex in another. We also found 1 case of acute demyelinating neuropathy, treated with antibiotherapy and immunoglobulins, and 1 chronic demyelinating neuropathy. Overall, diaphragmatic paralysis was frequent (18.6%). Antibiotherapy (mostly ceftriaxone 3-4 weeks) resulted in symptom resolution.This series gives an updated overview of the peripheral complications of neuroborreliosis to help identify this disease so that timely treatment could avoid axonal loss.
莱姆病在周围神经系统（PNS）中的表现仍鲜有描述。由于及时使用抗生素可使神经莱姆病的症状得到逆转，早期识别有助于避免不必要的轴突损失。我们的目的是描述2007年至2017年间在我们位于非流行地区（法国巴黎拉皮提-萨尔佩特里埃医院）的神经肌肉疾病中心确诊的累及PNS的神经莱姆病病例的特征。神经莱姆病的定义如下：伴有神经系统症状且无其他神经病变原因；脑脊液和血清分析（ELISA血清学检测呈阳性，经免疫印迹法确认）；以及经适当的抗微生物治疗后症状改善。2007年至2017年间在我们中心就诊的所有患者均接受了电生理研究。纳入了16例确诊的累及PNS的神经莱姆病病例：10例脑膜神经根神经炎、4例轴索性神经病和2例脱髓鞘性神经病（1例急性和1例慢性）。只有4例（25%）患者报告有蜱虫叮咬史。脑膜神经根神经炎的特征为淋巴细胞性脑膜炎、剧痛、颅神经麻痹以及影像学上神经根的强化。轴索性神经病患者表现为伴有剧痛的感觉症状，但无运动功能缺损，脑膜炎罕见。1例患者的神经活检显示淋巴细胞性血管炎。电生理测试显示下肢感觉或感觉运动性轴索性神经病（3例亚急性和1例慢性），1例患者为不对称性神经病，1例为对称性神经病，另1例为单肢性感觉性多神经病。我们还发现1例急性脱髓鞘性神经病，接受了抗微生物治疗和免疫球蛋白治疗，以及1例慢性脱髓鞘性神经病。总体而言，膈神经麻痹很常见（18.6%）。抗微生物治疗（主要是头孢曲松3 - 4周）使症状得到缓解。本系列研究对神经莱姆病的周围并发症进行了最新概述，以帮助识别该病，从而及时治疗可避免轴突损失。
