A retrospective study on differences in neuroborreliosis symptoms, signs and findings between adults and children

Abstract

<h3>Objectives</h3><p>Lyme neuroborreliosis (LNB) presents with a broad range of symptoms and its incidence is increasing in Finland. This study examines clinical differences in LNB between adults and children (< 16 years), emphasizing head and neck symptoms, the prognostic value of laboratory tests, the findings in brain MRI, and the impact of glucocorticoids on facial palsy (FP) recovery.</p><h3>Methods</h3><p>A retrospective analysis of LNB cases at Turku University Hospital (2011–2018) confirmed by intrathecal antibody production against <em>Borrelia</em> was conducted. With regard to cerebrospinal fluid pleocytosis, LNB was further classified as definite or possible. Patient characteristics were compared using appropriate statistical tests.</p><h3>Results</h3><p>In total 159 adult and 25 child LNB patients were found. The most common symptom in adults was radiculitis (37% vs. 8%, <em>p</em> = 0.03), while in children, it was FP (76% vs. 46%, <em>p</em> = 0.0052). In children, the absence of FP was linked to delayed diagnosis (5.5 ± 9.1 weeks vs. 0.97 ± 0.92 weeks <em>p</em> = 0.043). Of the pediatric LNB patients, 68% were seropositive for antibodies against <em>Borrelia</em> based on serum samples. Cranial nerve enhancement was observed in 26% of brain MRIs in the study cohort. No link between CSF findings or corticosteroid treatment and persisting FP was found.</p><h3>Conclusions</h3><p>In adults, the most common manifestation related to LNB was radiculitis, whereas in children it was FP. One third of the pediatric patients were seronegative for antibodies against <em>Borrelia</em>, emphasizing the importance of CSF analysis in the diagnosis of LNB. Corticosteroids did not affect the recovery from FP and CSF findings had no prognostic value on recovery from FP.</p>