title: Oral doxycycline for Lyme neuroborreliosis with symptoms of encephalitis, myelitis, vasculitis or intracranial hypertension.
abstract: OBJECTIVE
  The treatment recommendation for Lyme neuroborreliosis with central nervous system (CNS) symptoms is intravenous ceftriaxone, according to current American and European guidelines. For Lyme neuroborreliosis with peripheral nervous system (PNS) symptoms, treatment with intravenous ceftriaxone and oral doxycycline is considered equally effective. The purpose of this study was to evaluate the efficacy of oral doxycycline in the treatment of Lyme neuroborreliosis with CNS symptoms.
  
  
  METHODS
  Patients with Lyme neuroborreliosis who had undergone cerebrospinal fluid (CSF) sampling before and after treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, during the period 1990-2012, were included in this retrospective study. The CSF mononuclear cell count was used as a surrogate marker of treatment outcome. Comparisons of CSF mononuclear cell counts were made between patients with CNS symptoms and patients with PNS symptoms before and after treatment with oral doxycycline.
  
  
  RESULTS
  Twenty-six patients classified as having CNS symptoms and 115 patients classified as having PNS symptoms were included. The decline in CSF mononuclear cell counts did not differ significantly between the two groups of patients. All patients with CNS disease showed a marked clinical improvement after treatment, even though 62% had remaining symptoms at the end of follow-up.
  
  
  CONCLUSIONS
  Treatment with oral doxycycline resulted in a similar decrease in CSF mononuclear cell counts in patients with Lyme neuroborreliosis with CNS symptoms compared with patients with Lyme neuroborreliosis with PNS symptoms. The results indicate that oral doxycycline is an effective treatment for Lyme neuroborreliosis irrespective of the severity of symptoms.
authors.affiliation: Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Bremell
authors.forename: L
authors.initials: L
authors.lastname: Dotevall
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D004318:Doxycycline / Q000008:administration & dosage*; D004660:Encephalitis / Q000209:etiology*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D020852:Lyme Neuroborreliosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014657:Vasculitis / Q000209:etiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
keywords: Lyme borreliosis; Lyme neuroborreliosis; central nervous system Lyme disease; doxycycline