Can Children Develop Post-Treatment Lyme Disease Syndrome?
Long-term symptoms after pediatric neuroborreliosis
Most children recovered after early treatment
Only a small number developed symptoms consistent with PTLDS
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 reported persistent symptoms during follow-up.
Can Children Develop Post-Treatment Lyme Disease Syndrome?
Some children developed prolonged symptoms of neuroborreliosis (NB), including pain, fatigue or concentration difficulties, which can last more than 6 months after completing treatment. These patients were diagnosed with Post-Treatment Lyme Disease Syndrome (PTLDS).
Clinicians are divided over the cause of PTLDS, with some even questioning its existence. “Some experts believe that Borrelia burgdorferi (Bb) can trigger an auto-immune response causing symptoms that remain after the acute infection phase,” wrote the authors.
Among all children with NB, meningitis was the most common diagnosis, occurring in 19 (47.5%) patients. Facial nerve paralysis (FNP) occurred in one-quarter of the patients.
The most common symptoms included headaches, vomiting, and neck stiffness. Treatment included IV ceftriaxone for 21–28 days.
Although most children improved following treatment, researchers examined whether any developed persistent symptoms during long-term follow-up.
How Many Children Developed PTLDS?
Only 2 out of the 40 children had symptoms consistent with Post-Treatment Lyme Disease Syndrome.
One child reportedly had headaches which continued 6 months after treatment. Imaging and spinal fluid testing were negative. The child’s headaches continued at one year. The authors noted a stressful home situation.
A second child had facial nerve paresis at the 6-month follow-up but not 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 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 study did not address outcomes for children without facial nerve paralysis or meningitis. There are children who are not diagnosed in a timely manner whose outcomes may not be as successful.
- The study did not address outcomes in children with co-infections such as Babesia or Anaplasma.
- The study did not evaluate whether children developed complications of neurologic Lyme disease that may not have been detected during routine clinical assessments.
Frequently Asked Questions
Can children develop post-treatment Lyme disease syndrome?
Yes. In this study, 2 of 40 children had symptoms consistent with PTLDS following treatment for neuroborreliosis.
What are the long-term effects of Lyme disease in children?
Most children recover completely. A small number may continue to experience headaches, fatigue, pain, concentration difficulties, or lingering neurologic symptoms.
Does early treatment reduce the risk of long-term Lyme disease symptoms?
This study found favorable outcomes in most children who were diagnosed and treated for neuroborreliosis.
Can children develop POTS or neuropsychiatric symptoms after Lyme disease?
Some clinicians report seeing children with persistent symptoms including autonomic dysfunction, POTS, PANS, and neuropsychiatric manifestations following Lyme disease. Additional research is needed to better understand the frequency and causes of these conditions.
Clinical Takeaway
This pediatric neuroborreliosis study found favorable outcomes in most children following treatment. Only two children had symptoms consistent with PTLDS during follow-up, and one of those symptoms resolved by one year.
Although this study found little evidence of post-treatment Lyme disease syndrome in children treated early for neuroborreliosis, additional research is needed to better understand long-term outcomes in children with delayed diagnosis, co-infections, or persistent symptoms.
Early recognition and treatment of neuroborreliosis may improve outcomes, but additional studies are needed to evaluate children with delayed diagnosis, co-infections, POTS, PANS, neuropsychiatric symptoms, and other persistent manifestations.
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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.
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
