Lyme neuroborreliosis
ICD-10 A69.2 · ICD-11 1C1G.10

Management of Late Lyme Neuroborreliosis with Chronic Neurological Symptoms

Clinical Scenario

Late Lyme neuroborreliosis — also referred to as chronic Lyme neuroborreliosis — is characterised by neurological symptoms that develop gradually over months to years, representing a distinct and more advanced presentation of the disease.

Typical Manifestations
Treatment Goals

The primary objectives are resolution of neurological clinical symptoms and regression of CSF pleocytosis. Patients with impairing symptoms persisting after treatment may require follow-up CSF evaluation.

Treatment Approach

Management centres on a defined course of antibiotic therapy. The specific antibiotic options, their dosing, routes of administration, and the full treatment algorithm are detailed in the complete protocol.

Full regimen — including agent selection, dosing, and monitoring — available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3205/000349

Late Lyme neuroborreliosis (also known as chronic Lyme neuroborreliosis): Symptoms last for months to years.

The neurological symptoms develop gradually over months (to years).

Typical manifestations: encephalomyelitis with spastic-ataxic gait disorder and bladder disorder, encephalitic symptoms with change in personality, confusion, cognitive impairment, impaired consciousness and epileptic seizures.

Late Lyme neuroborreliosis should be treated with one of the following antibiotics: doxycycline, ceftriaxone, cefotaxime, penicillin G.

Antibiotic treatment for late Lyme neuroborreliosis should be carried out over a period of 14–21 days.

Treatment success should be assessed on the basis of the clinical symptoms.

If a patient continues to have impairing symptoms 6 months after treatment, CSF testing should be repeated; if there are doubts that the symptoms are improving, an earlier CSF follow-up analysis can be considered; if pleocytosis persists, a new course of antibiotic treatment should be carried out after other diagnoses have been ruled out.

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