No association between Borrelia burgdorferi antibodies and amyotrophic lateral sclerosis in a case-control study

Eur J Neurol. 2017 Jan;24(1):227-230. doi: 10.1111/ene.13197. Epub 2016 Nov 7.


Background and purpose: Previous studies, mostly case reports and uncontrolled studies, provide a low level of evidence for the hypothesized link between Lyme disease and amyotrophic lateral sclerosis (ALS). In order to make evidence-based recommendations regarding testing for Borrelia burgdorferi antibodies in the diagnostic work-up for ALS, the objective of this study was to explore the evidence for an association between these antibodies and ALS in a case-control design including age-, gender- and residency-matched controls.

Methods: A total of 491 patients with ALS were matched to 982 controls. IgG titers against B. burgdorferi were determined by an enzyme-linked immunosorbent assay and, in the case of positivity or borderline results, a western blot was performed. Conditional logistic regression and Fisher's exact tests were used to compare the antibody titers or positivity between patients and controls.

Results: No difference in seroprevalence of Borrelia was found between patients (4.1%) and controls (5.9%). Clinical characteristics and survival were similar between seropositive and seronegative patients. Moreover, patients with a spinal onset were not more frequently seropositive compared with patients with a bulbar onset (P = 0.47), and neither were patients with a short diagnostic delay of <6 months compared with controls (P = 0.69). None of the 20 patients with a diagnostic delay of <3 months tested positive for IgM antibodies, suggestive of a recent infection.

Conclusion: This large case-control study provides evidence for a lack of association between B. burgdorferi antibodies and ALS, and therefore does not support the inclusion of routine testing for these antibodies in the diagnostic work-up in patients with classical ALS.

Keywords: Borrelia; Lyme; amyotrophic lateral sclerosis; diagnosis; serology.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amyotrophic Lateral Sclerosis / blood
  • Amyotrophic Lateral Sclerosis / immunology*
  • Amyotrophic Lateral Sclerosis / microbiology
  • Antibodies, Bacterial / blood*
  • Borrelia burgdorferi / immunology*
  • Case-Control Studies
  • Delayed Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Seroepidemiologic Studies
  • Young Adult


  • Antibodies, Bacterial