Can Children Develop Post-Treatment Lyme Disease Syndrome?
Long-term symptoms after pediatric neuroborreliosis
Most children recovered following treatment
Only a small number had persistent findings during follow-up
Can children develop post-treatment Lyme disease syndrome (PTLDS)? Researchers examined outcomes in 40 children treated for neuroborreliosis and found that most recovered well. However, a small number had persistent symptoms or neurologic findings during follow-up.
What Did the Pediatric Study Find?
PTLDS generally refers to symptoms such as fatigue, pain, or cognitive difficulties that persist for at least six months after recommended treatment for Lyme disease. In this cohort, two children had persistent findings during follow-up that the authors considered consistent with PTLDS.
The cause of PTLDS remains uncertain. “Some experts believe that Borrelia burgdorferi (Bb) can trigger an auto-immune response causing symptoms that remain after the acute infection phase,” the authors wrote.
Among the children with neuroborreliosis, meningitis was the most common diagnosis, occurring in 19 of 40 patients (47.5%). Facial nerve paralysis occurred in one-quarter of the patients.
Common presenting symptoms included headaches, vomiting, and neck stiffness. Treatment included IV ceftriaxone for 21–28 days.
Although most children improved following treatment, the researchers examined whether any had persistent symptoms or neurologic findings during long-term follow-up.
How Many Children Had Findings Consistent With PTLDS?
Two of the 40 children had persistent findings that the authors considered consistent with Post-Treatment Lyme Disease Syndrome.
One child had headaches that continued six months after treatment. Imaging and cerebrospinal fluid testing did not identify another explanation. The headaches were still present at one year. The authors also noted that the child had a stressful home situation.
A second child had residual facial nerve paresis at the six-month follow-up. The paresis was no longer present at one year.
Clinical Perspective
This study found favorable outcomes for most children diagnosed and treated for neuroborreliosis. However, in my clinical practice, I have evaluated children and adolescents with persistent symptoms following Lyme disease, including fatigue, cognitive difficulties, dizziness, headaches, sleep disturbances, autonomic dysfunction, postural orthostatic tachycardia syndrome (POTS), Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), and other manifestations of neuropsychiatric Lyme disease.
These clinical experiences highlight an important limitation of many pediatric Lyme disease studies. Children with delayed diagnosis, co-infections, complex neurologic presentations, or symptoms that emerge after routine follow-up may not be fully represented in published reports. Additional research is needed to better understand long-term outcomes in these patient populations.
Editor’s Note
- The findings from this small neuroborreliosis cohort may not apply to children with other Lyme disease presentations or to those whose diagnosis and treatment were delayed.
- The study did not evaluate long-term outcomes in children with co-infections such as Babesia or Anaplasma.
- Routine clinical assessments may not identify every possible persistent neurologic, cognitive, autonomic, or functional symptom.
Frequently Asked Questions
Can children develop post-treatment Lyme disease syndrome?
Yes. In this study, 2 of 40 children had persistent findings during follow-up that the authors considered consistent with PTLDS after treatment for neuroborreliosis.
What are the long-term effects of Lyme disease in children?
Most children in this study recovered without persistent symptoms. A small number had continuing headaches or a residual neurologic finding during follow-up. Other studies and clinical reports have described fatigue, pain, cognitive difficulties, and lingering neurologic symptoms in some children.
Does early treatment reduce the risk of long-term Lyme disease symptoms?
Most children in this study had favorable outcomes following diagnosis and treatment for neuroborreliosis. However, this observational study was not designed to establish how much early treatment reduced the risk of persistent symptoms.
Can children develop POTS or neuropsychiatric symptoms after Lyme disease?
Persistent autonomic and neuropsychiatric symptoms, including POTS and PANS-like presentations, have been reported or observed clinically following Lyme disease. Additional research is needed to determine how frequently these conditions occur and whether Lyme disease contributes directly to them.
Clinical Takeaway
This pediatric neuroborreliosis study found favorable outcomes for most children following treatment. Two children had persistent findings that the authors considered consistent with PTLDS during follow-up. The residual facial nerve paresis reported in one child was no longer present at one year.
Although this study found a low frequency of persistent findings following treatment for pediatric neuroborreliosis, additional research is needed to better understand long-term outcomes in children with delayed diagnosis, co-infections, complex presentations, or persistent symptoms.
Early recognition and appropriate treatment of neuroborreliosis are important. Additional studies are needed to evaluate children with delayed diagnosis, co-infections, POTS, PANS, neuropsychiatric symptoms, and other persistent manifestations.
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- Post-Treatment Lyme Disease Syndrome
References
- Myszkowska-Torz A, Frydrychowicz M, Tomaszewski M, Figlerowicz M, Mania A, Mazur-Melewska K. Neuroborreliosis and Post-Treatment Lyme Disease Syndrome: Focus on Children. Life (Basel). 2023;13(4):900. doi:10.3390/life13040900.
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
