NEUROLOGICAL FEATURES OF LYME-DISEASE IN 25 CASES

We studied retrospectively the cases of neurological forms of Lyme dis ease observed in two internal and two neurological departments from 19 86 till 1993. Twenty five cases have been collected among 15 men and t en women whose mean age was 61 years. Tick bites were previously notic ed in 11 cases. Erythema chronicum migrans (ECM) was mentionned in 16 cases mostly on lower limbs. The mean time between ECM and the onset o f neurological symptoms was less than 1 month in 11 cases, 2 months in three cases, and 6 months in two cases. Neurological abnormalities we re often associated in the same patient. Hyperalgic radiculitis (n = 1 6), mainly noticed in the ECM territory (n = 10) was only sensitive in six cases and associated with motor deficit in ten. Atypical polyradi culoneuritis was achieved in six cases. Clinical (n = 5) or biological (n = 22) meningitis could occur: CSF was clear with pleiocytosis (132 per mm(3)), mainly lymphocytic, and hyperproteinorachia (1.2 g/l) wit h normoglycorachia. An increase of the CSF immunoglobulins G with olig oclonal fragmentation was noticed in 11 cases. Cranial neuropathy was frequent: VII(n = 8), VI(n = 2), III, IV, VIII (n = 1). Encephalitis ( with white matter demyelination) resolved partially in two cases. Diag nosis was always confirmed by Borrelia burgdorferi serology (indirect immunofluorescence) with a significant increase of the antibodies tite r (n = 17) or a CSF titer > 1/4 (n = 11). Syphilitic serology was alwa ys negative. All patients were treated with parenteral beta lactamins and four with corticosteroids. Outcome was favorable in 20 patients wi th incomplete resolution of neurological symptoms in two patients.