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From the Department of Neurology (F.B., M.F., J.d.S., C.T.), the Laboratory of Bacteriology and National Reference Centre for Borrelia (B.J., S.J.d.M.), the Department of Infectious Diseases (Y.H., V.R., D.C.), University Hospital of Strasbourg, Louis Pasteur University, Strasbourg; the Department of Internal Medicine (G.B.), Pasteur Hospital, Colmar; and GEBLY (Study Group for Lyme Borreliosis) (F.B., B.J., J.d.S., S.J.d.M., Y.H., D.C., C.T.), Strasbourg, France.
Address correspondence and reprint requests to Dr. Frederic Blanc, Department of Neurology, University Hospital of Strasbourg, 1, Place de l'hôpital, 67091 Strasbourg Cedex, France blanc.frdrc{at}free.fr
Background: No consensual criteria exist to diagnose neuroborreliosis. The intrathecal anti-Borrelia antibody index (AI) is a necessary criterion to diagnose neuroborreliosis in Europe, but not in the United States. Previous studies to determine the diagnostic value of the AI found a sensitivity ranging from 55% to 80%. However, these studies included only typical clinical cases of meningitis or meningoradiculitis, and none had a control group with CSF anti-Borrelia antibodies.
Methods: We studied a sample of 123 consecutive patients with clinical signs of neurologic involvement and CSF anti-Borrelia antibodies. We determined the AI for all patients and a final diagnosis was made. Patients were then divided into three groups (neuroborreliosis, possible neuroborreliosis, control).
Results: Thirty of the 40 patients with neuroborreliosis had a positive AI (AI sensitivity = 75%). Two of the 74 patients with another neurologic diagnosis had a positive AI (AI specificity = 97%).
Conclusion: The antibody index has a very good specificity but only moderate sensitivity. Given the lack of consensual criteria for neuroborreliosis and the absence of a "gold standard" diagnostic test, we propose pragmatic diagnostic criteria for neuroborreliosis, namely the presence of four of the following five items: no past history of neuroborreliosis, positive CSF ELISA serology, positive anti-Borrelia antibody index, favorable outcome after specific antibiotic treatment, and no differential diagnosis. These new criteria will need to be tested in a larger, prospective cohort.
Editorial, see page 949
*These two authors contributed equally to this study.
Disclosure: The authors report no conflicts of interest.
Received August 15, 2006. Accepted in final form March 23, 2007.
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Neurology 2007 69: 949-950.
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