title: Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome.
abstract: BACKGROUND
  Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.
  
  
  METHODS
  Children being evaluated for NB (n = 177) in southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but no Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid. Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).
  
  
  RESULTS
  Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.
  
  
  CONCLUSIONS
  Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.
authors.affiliation: Pediatric Clinic at the University Hospital, Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. hedinskogman@ltdalarna.se
authors.forename: Barbro Hedin
authors.initials: BH
authors.lastname: Skogman
authors.forename: Stefan
authors.initials: S
authors.lastname: Croner
authors.forename: Maria
authors.initials: M
authors.lastname: Nordwall
authors.forename: Mattias
authors.initials: M
authors.lastname: Eknefelt
authors.forename: Jan
authors.initials: J
authors.lastname: Ernerudh
authors.forename: Pia
authors.initials: P
authors.lastname: Forsberg
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D025065:Borrelia burgdorferi / Q000276:immunology; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004318:Doxycycline / Q000627:therapeutic use; D004797:Enzyme-Linked Immunosorbent Assay; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid / Q000276:immunology; D007964:Leukocytosis / Q000134:cerebrospinal fluid; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M; D002443:Ceftriaxone; D004318:Doxycycline