# Guidelines for diagnosis and treatment in neurology – Lyme neuroborreliosis

## TL;DR

This paper presents updated guidelines for diagnosing and treating Lyme neuroborreliosis, a tick-borne neurological disease, based on expert consensus and new evidence.

## Contribution

The paper introduces new Class Ia evidence for shorter antibiotic treatment and revised recommendations for children and steroid use.

## Key findings

- A 14-day antibiotic course is sufficient for early neuroborreliosis.
- Steroids should not be used with antibiotics for facial palsy in confirmed cases.
- Doxycycline can now be used for children under 8 years old.

## Abstract

Lyme disease is the most common tick-borne infectious disease in Europe. Neurological manifestations occur in 3–15% of infections and can present as polyradiculitis, meningitis, and rarely as encephalomyelitis. The disease is treatable with antibiotics. The S3 guideline “Neuroborreliosis” has been updated in accordance with the methodological standards of the “Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V.” (AWMF register number 030/071). Eighteen AWMF member societies, the Robert Koch Institute, the “Paul-Ehrlich-Gesellschaft für Infektionstherapie”, the “Schweizerische Neurologische Gesellschaft”, the “Österreichische Gesellschaft für Neurologie“, the “Deutsche Borreliose-Gesellschaft” and two patient organizations were involved in the update. The guideline aimed at physicians in practice and hospital settings who are involved in the treatment of neuroborreliosis in children and adults. For the first time, there is Class Ia evidence that a 14-day course of antibiotics is therapeutically sufficient in early neuroborreliosis. Additionally, it is now recommended that the administration of steroids alongside antibiotic therapy is not advised in cases of facial palsy within the context of a neuroborreliosis that is probable or confirmed according to diagnostic criteria. The age limit for doxycycline in the treatment of neuroborreliosis in children under 8 years has been removed. There are still no valid study data on the effectiveness of combination antibiotic treatments. A systematic review on the therapy of so-called Post-Treatment Lyme Disease Syndrome (PTLDS) showed that parameters such as quality of life, fatigue, depression, and cognition do not respond to antibiotic therapy.