DIAGNOSTIC-VALUE OF CEREBROSPINAL-FLUID EXAMINATION IN CHILDREN WITH PERIPHERAL FACIAL PALSY AND SUSPECTED LYME BORRELIOSIS

Our objective was to determine the diagnostic value of CSF examination s in the diagnosis of neuroborreliosis in children with peripheral fac ial palsy (PFP). Paired serum and CSF samples from 21 children with PF P were investigated for antibody responses to Borrelia burgdorferi ant igens using three different ELISA systems and one Western blot assay. Twenty of the children (95%) had detectable immunoglobin (Ig) NI or Ig G in the acute-phase serum, but discrepancies between serologic assays were noted in 33% for IgM and 22 to 50% for IgG. Intrathecal specific -antibody production was detected in five of the 20 seropositive child ren (25%). These five patients showed seroconversion in convalescent s era in at least one assay. Similar seroconversion suggesting recent in fection with B. burgdorferi was observed in eight of the 10 children ( 80%) without intrathecal specific-antibody production, from whom conva lescent serum samples could be obtained. All patients with intrathecal antibodies or seroconversion had shown lymphocytic pleocytosis in the acute phase of PFP. In the acute phase of PFP the detection of intrat hecal production of antibodies to B. burgdorferi allows prompt diagnos is of neuroborreliosis. For patients with lymphocytic pleocytosis but no detectable intrathecal antibodies, analysis of convalescent serum m ay help to establish this diagnosis.