Lyme Neuroborreliosis in Children: Report of 9 Cases
Lyme neuroborreliosis can affect the nervous system in children
Facial nerve palsy and meningitis are among the most common presentations
Rare neurologic complications may complicate diagnosis
“The exact prevalence of NB [neuroborreliosis] in France is unknown because reporting is not required,” explains Guet-Revillet. “Nevertheless, the prevalence seems rare.”
The outcome for the 9 children “was favorable” after a 2- to 3-week course of third-generation cephalosporin.
However, the outcomes have not been so positive for other pediatric cases. According to the authors’ review of the literature:
“Rare manifestations associated with NB in children include myoclonia, ataxia, vertigo, cranial polyneuritis with the exception of facial nerve palsy, acute transverse myelitis, and benign and isolated intracranial hypertension.”
“Exceptional cases of acute disseminated encephalomyelitis and cerebrovascular complications such as stroke have been reported.”
Rare neurologic complications of Lyme neuroborreliosis in children
Most children with Lyme neuroborreliosis recover after appropriate antibiotic treatment. However, the literature reviewed by Guet-Revillet identified several uncommon neurologic complications including ataxia, vertigo, acute transverse myelitis, intracranial hypertension, acute disseminated encephalomyelitis (ADEM), and stroke.
A more recent review by Bruinsma and colleagues found that children with Lyme neuroborreliosis often present differently than adults. While painful meningoradiculitis is common in adults, children are more likely to present with facial nerve palsy and/or subacute meningitis. In some cases, headache may be the only manifestation. Fatigue, appetite loss, and mood changes have also been reported, particularly in younger children.
Baumann and colleagues described several uncommon manifestations of pediatric Lyme neuroborreliosis, including seizures, acute transverse myelitis, meningoradiculitis with pain and paresthesias, and cranial nerve palsies other than facial nerve palsy. All four children improved following antibiotic treatment.
Although these complications are rare, they highlight the broad spectrum of neurologic Lyme disease. Clinicians may need to consider Lyme neuroborreliosis in children presenting with unexplained neurologic symptoms, particularly in regions where Lyme disease is endemic.
Diagnosing some of these children can be extremely challenging, Guet-Revillet points out, “because of the clinical and biological similarity of [neuroborreliosis] to viral meningitis (especially herpes simplex virus and varicella-zoster virus meningitis) and tuberculous meningitis.”
This difficulty is exacerbated by the long delay involved in obtaining serological test results. Similar diagnostic challenges have been described in studies involving pediatric Lyme disease and other manifestations of neurologic Lyme disease.
Frequently Asked Questions
What is Lyme neuroborreliosis in children?
Lyme neuroborreliosis occurs when Borrelia bacteria affect the nervous system, leading to symptoms such as meningitis, facial nerve palsy, headaches, or other neurologic manifestations.
Can Lyme disease cause meningitis in children?
Yes. Lyme meningitis is one of the more common manifestations of pediatric Lyme neuroborreliosis.
Can Lyme disease cause stroke in children?
Stroke is a rare complication of Lyme neuroborreliosis, but isolated pediatric cases have been reported in the medical literature.
What conditions can mimic Lyme neuroborreliosis?
According to Guet-Revillet, viral meningitis and tuberculous meningitis may resemble Lyme neuroborreliosis and complicate diagnosis.
Clinical Takeaway
Most children with Lyme neuroborreliosis improve following appropriate antibiotic treatment. However, rare neurologic complications including ADEM, intracranial hypertension, transverse myelitis, seizures, and stroke have been reported.
Early recognition of pediatric Lyme neuroborreliosis may help prevent delays in diagnosis and treatment, particularly when symptoms resemble other causes of meningitis or neurologic disease.
Related Articles
Pediatric Lyme disease
Neurologic Lyme disease
What happens to the brain during acute Lyme neuroborreliosis?
Long-term problems for some Lyme neuroborreliosis patients
References:
- Guet-Revillet H, Levy C, Vallet C, Maghraoui-Slim V, Dommergues MA, Hentgen V, Paget C, Laugel V, Cohen R, Ferroni A. Lyme neuroborreliosis in children: Report of nine cases and a review of the literature. Arch Pediatr. 2019;26(3):133-137.
- Bruinsma RA, Zomer TP, Skogman BH, Boele van Hensbroek M, Hovius JW. Clinical manifestations of Lyme neuroborreliosis in children: a review. Eur J Pediatr. 2023;182(5):1965-1976.
- Kozak S, Kaminiów K, Kozak K, Paprocka J. Lyme Neuroborreliosis in Children. Brain Sci. 2021;11(6):758.
- Baumann M, Birnbacher R, Koch J, Strobl R, Rostásy K. Uncommon manifestations of neuroborreliosis in children. Eur J Paediatr Neurol. 2010;14(3):274-277.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
