Kaiser R
Neurologische Klinik und Poliklinik, Albert-Ludwigs-Universität Freiburg, Germany.
J Neurol. 1998 May;245(5):247-55. doi: 10.1007/s004150050214.
Neuroborreliosis, a manifestation of infection with the spirochete Borellia burgdorferi, has become the most frequently recognised arthropod-borne infection of the nervous system in Europe and the USA. The best criterion of an early infection with B. burgdorferi is erythema migrans (EM), but this is present in only about 40-60% of patients with validated borreliosis. Therefore use of the duration of the disease as a classification criterion for neuroborreliosis is increasing, the chronic form being distinguished from the acute when symptoms persist for more than 6 months. The diverse manifestations of neuroborreliosis require that it be included in the differential diagnosis of many neurological disorders. In Europe, meningopolyradiculoneuritis (Bannwarth's syndrome) represents the most common manifestation of acute neuroborreliosis, with the facial nerve being affected much more frequently than the other cranial nerves. Clinical symptoms affecting the central nervous system are rarely observed and then mostly in chronic courses. By far the most common manifestation of chronic neuroborreliosis is encephalomyelitis with spastic-ataxic disturbances and a disturbance of micturition. The current diagnosis of neuroborreliosis is a clinical one, which has to be confirmed by laboratory testing. In most patients, examination of the cerebrospinal fluid (CSF) reveals lymphocytic pleocytosis, damage to the blood-CSF-barrier and an intrathecal synthesis immunoglobulin (Ig) M, IgG, and sometimes IgA. Confirmation of a borrelial infection of the nervous system requires demonstration of an intrathecal synthesis of borrelial-specific antibodies in the CSF or detection of borrelial DNA in the CSF by polymerase chain reaction (PCR). There is no generally accepted therapeutic regime for the treatment of neuroborreliosis, but recent studies have shown ceftriaxone 2 g/day and cefotaxime 6 g/day to be effective in acute and chronic courses. Penicillin G 20 mega units/day and doxycycline 200 mg/day may be suitable for uncomplicated meningopolyneuritis, without involvement of the central nervous system. The durationof treatment--at least 2 weeks in the acute forms and 3 weeks in the chronic forms of neuroborreliosis--is very important for successful treatment. Corticosteroids are recommended only for patients with severe pain that does not respond to antibiotics an analgesics.
神经莱姆病是由伯氏疏螺旋体感染引起的一种疾病，已成为欧洲和美国最常见的节肢动物传播的神经系统感染。早期伯氏疏螺旋体感染的最佳标准是游走性红斑（EM），但在确诊的莱姆病患者中只有约40%-60%会出现这种症状。因此，将病程作为神经莱姆病的分类标准的情况越来越多，当症状持续超过6个月时，慢性形式与急性形式相区分。神经莱姆病的多种表现形式使得它需要被纳入许多神经系统疾病的鉴别诊断中。在欧洲，脑膜多神经根神经炎（班沃思综合征）是急性神经莱姆病最常见的表现形式，面神经受累比其他颅神经更频繁。影响中枢神经系统的临床症状很少见，且大多出现在慢性病程中。到目前为止，慢性神经莱姆病最常见的表现形式是伴有痉挛性共济失调障碍和排尿障碍的脑脊髓炎。目前神经莱姆病的诊断是临床诊断，必须通过实验室检测来证实。在大多数患者中，脑脊液（CSF）检查显示淋巴细胞增多、血脑屏障受损以及鞘内合成免疫球蛋白（Ig）M、IgG，有时还有IgA。确诊神经系统的伯氏疏螺旋体感染需要证明脑脊液中存在鞘内合成的伯氏疏螺旋体特异性抗体，或者通过聚合酶链反应（PCR）检测脑脊液中的伯氏疏螺旋体DNA。目前尚无普遍接受的神经莱姆病治疗方案，但最近的研究表明，头孢曲松2g/天和头孢噻肟6g/天在急性和慢性病程中均有效。青霉素G 2000万单位/天和多西环素200mg/天可能适用于无中枢神经系统受累的单纯性脑膜多神经根炎。治疗时长——急性形式的神经莱姆病至少2周，慢性形式至少3周——对治疗成功非常重要。仅建议对使用抗生素和镇痛药无效的严重疼痛患者使用皮质类固醇。
