A Neurologist's View of Lyme Disease and Other Tick-Borne Infections

Semin Neurol. 2019 Aug;39(4):440-447. doi: 10.1055/s-0039-1692143. Epub 2019 Sep 18.


Tick-borne infections-including tick-borne encephalitis viruses, represented in the United States by rare infections with Powassan and deer tick viruses, and more often Lyme disease-are of increasing importance to neurologists. Lyme neuroborreliosis (LNB) causes all or part of a triad including meningitis, radiculoneuritis, and cranial neuritis. Rarely, parenchymal brain and spinal cord involvement occur, with focal findings on examination and magnetic resonance imaging (MRI). LNB diagnosis requires plausible exposure, objective evidence of nervous system involvement, and, generally, positive two-tier serology. Central nervous system (CNS) LNB is almost always accompanied by abnormal cerebrospinal fluid (CSF) (cells, protein), often with intrathecal antibody production, which is determined by concentration-adjusted comparison of serum and CSF antibody. Measuring CSF antibody in isolation and nucleic acid-based testing of CSF are not useful in LNB and should be avoided. LNB treatment is highly effective with a 2- to 3-week course of antibiotics. Increasing evidence suggests that LNB not involving the CNS parenchyma can be treated successfully with oral doxycycline.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Borrelia / isolation & purification*
  • Humans
  • Lyme Neuroborreliosis / blood*
  • Lyme Neuroborreliosis / diagnosis*
  • Lyme Neuroborreliosis / drug therapy
  • Nervous System Diseases / blood*
  • Nervous System Diseases / diagnosis*
  • Nervous System Diseases / drug therapy
  • Neurologists*
  • Tick-Borne Diseases / blood
  • Tick-Borne Diseases / diagnosis
  • Tick-Borne Diseases / drug therapy


  • Anti-Bacterial Agents