Late Lyme Neuroborreliosis with Persistent Neurological Symptoms After Initial Antibiotic Therapy
Late (chronic) Lyme neuroborreliosis produces neurological symptoms that unfold gradually over months to years. When an initial antibiotic course does not bring full resolution — and CSF abnormalities persist — a further structured step is indicated.
Clinical Scenario
Symptoms developing gradually over months to years, including encephalomyelitis with spastic-ataxic gait disorder and bladder disorder, as well as encephalitic features: personality change, confusion, cognitive impairment, impaired consciousness, and epileptic seizures.
Why the Previous Treatment Was Not Sufficient
- The patient completed an initial antibiotic course (doxycycline, ceftriaxone, cefotaxime, or penicillin G).
- Impairing neurological symptoms persist 6 months or more after that treatment ended.
- Repeat CSF testing shows continuing pleocytosis, indicating that the target of full neurological and CSF normalisation was not reached.
Next-Step Approach
Once other diagnoses have been excluded, a new course of antibiotic treatment is carried out. The complete protocol specifies which agent to select and how the decision is structured.
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
- 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.