Post-Treatment Lyme Disease Syndrome in Children

Researchers examined long-term outcomes after pediatric neuroborreliosis.
Most children improved following treatment for Lyme disease.
A small number continued to experience prolonged symptoms.

Some children developed prolonged symptoms following treatment for Lyme neuroborreliosis (NB), including pain, fatigue, or concentration difficulties lasting longer than 6 months after completing therapy.

These patients were diagnosed with post-treatment Lyme disease syndrome (PTLDS).

In the article “Neuroborreliosis and Post-Treatment Lyme Disease Syndrome: Focus on Children,” Myszkowska-Torz and colleagues discussed ongoing questions regarding the cause and recognition of PTLDS in children.

“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.

Neuroborreliosis Symptoms in Children

Among the children with neuroborreliosis:

• Meningitis was the most common diagnosis, occurring in 19 patients (47.5%)
• Facial nerve paralysis (FNP) occurred in approximately one quarter of the children
• Common symptoms included headaches, vomiting, and neck stiffness

Treatment included intravenous ceftriaxone for 21–28 days.

Persistent Symptoms After Treatment

Only 2 of the 40 children had symptoms considered consistent with post-treatment Lyme disease syndrome.

One child continued to experience headaches 6 months after treatment. Imaging studies and spinal fluid testing were negative. The headaches reportedly persisted at one year follow-up. The authors also noted a stressful home situation.

A second child continued to have facial nerve paresis at the 6-month follow-up visit, although the symptoms had resolved by one year.

Questions About Long-Term Outcomes

The study primarily focused on children diagnosed and treated relatively early in the course of neuroborreliosis.

Several important questions remain unanswered, including outcomes in children who:

• Are diagnosed later in the illness course
• Present without meningitis or facial nerve paralysis
• Have tick-borne coinfections such as Babesia or Anaplasmosis
• Develop symptoms not detected during routine follow-up evaluations

To learn more, see pediatric Lyme disease, persistent Lyme disease, and how long PTLDS symptoms may last.

Clinical Perspective

Most children in this study improved following treatment for Lyme neuroborreliosis.

However, the persistence of headaches, fatigue, cognitive symptoms, or neurologic deficits in a small number of children highlights the ongoing debate surrounding post-treatment Lyme disease syndrome.

The study also underscores the importance of continued follow-up in children with neurologic Lyme disease.

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