“The exact prevalence of Lyme neuroborreliosis in France is unknown because reporting is not required,” Guet-Revillet explains. “Nevertheless, the condition appears to be rare.”

The outcome for the nine children described in this case series was favorable following a two- to three-week course of third-generation cephalosporin therapy.

However, outcomes have not been uniformly positive in other reported pediatric cases. In their review of the literature, the authors note that rare manifestations of Lyme neuroborreliosis in children include myoclonia, ataxia, vertigo, cranial polyneuritis (excluding isolated facial nerve palsy), acute transverse myelitis, and benign intracranial hypertension.

Exceptional cases of acute disseminated encephalomyelitis and cerebrovascular complications, including stroke, have also been reported.

Diagnosing Lyme neuroborreliosis in children can be challenging, Guet-Revillet notes, because of its clinical and biological similarity to viral meningitis—particularly herpes simplex virus and varicella-zoster virus meningitis—as well as tuberculous meningitis. This difficulty is further compounded by delays in obtaining serologic test results.