Researchers at Falun General Hospital and other centers in Sweden determined the long-term neurologic outcome of 84 children with confirmed Lyme neuroborreliosis (LNB). A neurologic re-examination at a mean age of 13 years and a median follow-up of 5 years after diagnosis found a total recovery rate of 73% (n=61). None had progressive neurologic symptoms. Definite sequelae (objective neurologic findings) were found in 16 (19%) patients, and possible sequelae (nonspecific signs related in time with LNB diagnosis) in 7 (8%). Sequelae were motor in 8 patients, sensory in 8, and both motor and sensory in 7. Eleven (21%) of 53 patients with acute facial nerve palsy at diagnosis had moderate persistent facial palsy at follow-up. Persistent neuropathy was diagnosed in 1 patient, trigeminal neuropathy in 1, hemiparesis following an LNB stroke in 1, polyneuropathy in 1, and peroneal nerve palsy in 1. Romberg test was positive in 3 patients, and vertigo occurred in 1. Fine motor incoordination with dysgraphia was diagnosed in 3. Possible sequelae in 7 patients included paresthesia, pain, and imbalance. Impaired school performance and daily activities affected 37% of children with definite sequelae, 57% of the possible sequelae group, and 15% of the no sequelae group. Nonspecific subjective symptoms, including headache, fatigue, and memory or concentration difficulties, were similar in the 3 patient groups and a control group of 84 children. Age, gender, duration of symptoms at diagnosis, and antibiotic treatment did not differ significantly in patients with or without sequelae. [1]

COMMENT. Acute facial nerve palsy is a common symptom of LNB, and a significant number (21%) will persist at follow-up. In a previous study of long-term outcome (3-5 years) of facial palsy in LNB, one-half of patients with subjective symptoms of residual facial palsy had signs of mild to moderate dysfunction on clinical examination, III-IV on the House-Brackman grading scale (I normal-VI no movement) [2]. Subjective symptoms, objective signs, and neurophysiological test results show no clear correlation.

Since LNB is amenable to antibiotic treatment, a high index of suspicion and early diagnosis of acute neurologic complications is important. Examples of more common neurologic manifestations include, in addition to facial palsy, lymphocytic meningitis, mononeuropathy multiplex, and painful radiculoneuritis. [3]