Most children recover from Lyme neuroborreliosis By Will Boggs, MD Will Boggs, Md - Wed Dec 31, 3:50 pm ET
NEW YORK (Reuters Health) - Clinical recovery is usually satisfactory in children treated for Lyme neuroborreliosis - infection of the nervous system that usually occurs in the late stages -- and subsequent fatigue or headache are not attributable to the condition, according to a report in The Pediatric Infectious Disease Journal.
Antibiotic treatment is effective and long-term side effects of the disease are rare, Dr. Barbro Hedin Skogman from the Center for Clinical Research Dalarna, Falun, Sweden, told Reuters Health. "Nonspecific symptoms are not due to neuroborreliosis."
Hedin Skogman and colleagues studied 177 children being evaluated for Lyme neuroborreliosis in an area in Sweden in which the disease is prevalent, to investigate their clinical outcomes and to identify factors of importance for recovery.
The patients were classified as having confirmed neuroborreliosis, possible neuroborreliosis, or "not determined." They were followed for 6 months and compared with a matched control group of 174 children with Lyme disease.
Symptoms that occurred more often in the confirmed neuroborreliosis group than in the "not determined" group included fatigue, facial nerve palsy, loss of appetite, and fever, the authors report.
Patients with confirmed neuroborreliosis were more likely to have irregularities in the cerebrospinal but laboratory results were abnormal in all patients.
Antibiotic treatment was given to 69 percent of the children. At 2 months, 117 patients had recovered completely, and by 6 months 140 had recovered. No patient reported progressive or reoccurring neurological symptoms.
The only significant persistent symptom at follow-up that occurred only among confirmed patients was facial nerve palsy, which persisted in 11 patients (6 percent) at the 6-month follow-up.
None of the variables investigated correlated with disease course among confirmed patients or among patients who received antibiotic treatment.
"Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls," the investigators found.
Hedin Skogman added that "a 5-year follow-up with neurological and otoneurological examination as well as reported symptoms" is planned.
SOURCE: The Pediatric Infectious Disease Journal, December 2008.
-------------------- Lou B Posts: 2200 | From Mount Hope, New Jersey, USA | Registered: Oct 2000
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lymielauren28
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Sounds like a big fat load of bull to me...
Lauren
-------------------- "The only way out is through" Posts: 1434 | From mississippi | Registered: Nov 2007
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I guess neither of my sons read this.... otherwise they's know they were well a LONG time ago Posts: 758 | From now TX | Registered: Mar 2001
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Hmm, they had 177 sick kids with neurological problems, and they treated 69% (122) with antibiotics.
At 2 months, 117 kids recovered, and at 6 months 140 recovered. (Wonder how many of the 140 were treated with abx?).
From the abstract:
quote: However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients
Wonderful - so this says that in Sweden (where B. garinii, not Bb sensu stricto is the major factor in neuroborreliosis), if your kid gets hospitalized with neurological issues it is likely that 6 months from now they will not have any more headaches than other kids, but there is better than 1 in 10 chance of facial disfigurement.
People actually get paid to write this stuff?
Posts: 263 | From Capital Region, NY, USA | Registered: Jun 2008
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I've split it up in case it's too wide for the page.
The summary at the beginning of the thesis says 22% of kids had facial palsy as a permanent consequence. However, it's hard to tell which group of children, whether the author meant 22% of one group, and that worked out as 11% of the whole group.
Someone else with a sharper brain might see if they read the whole thing. There's a lot of good technical data in there as far as I can see; I don't think the person who wrote the thesis was the sole writer of the papers that came out of her thesis and as a PhD student, toeing the line might be advantageous in one's future career.
One thing that's happened is that the news of this study has come into my mail box about 5 or 6 times through google alerts, so it's getting the maximum publicity under the heading that neuroborreliosis is no big deal in kids. Reuters and yahoo and aol and google and all the media are taking this up.
Just imagine how that headline could be reworded as "22% of kids are permanently disfigured when they get neuroborreliosis".
We are all fed through the main media with what the press barons want us to hear I'm afraid.
The aim of this thesis was to study clinical, immunological and laboratory characteristics in children being evaluated for NB in a Lyme endemic area of Sweden, in order to identify factors of importance for prognosis and clinical recovery. A total of 250 patients and 220 controls were included during 1998-2005, with a prospective and a retrospective part.
Less than half (41%) of children with signs and symptoms indicative of NB got the diagnosis confirmed by detection of Borrelia specific flagella antibodies in CSF (clinical routine method). Surprisingly few patients were diagnosed as having other infectious or neurologic diseases and consequently, many patients ended up with an uncertain diagnosis.
However, four new Borrelia antigens (DbpA, BBK32, OspC, IR6) were evaluated and performed well in laboratory diagnostics. If they were combined in a panel, together with the flagella antigen, the sensitivity was 82% and the specificity 100%, leading to improved diagnostic accuracy in children with NB, as compared to using the routine flagella antibody test alone.
Clinical recovery at the 6-month follow-up (n=177) was generally good and nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. No patient was found to have recurrent or progressive neurologic symptoms.
However, permanent facial nerve palsy was found in 22% of patients at the 2-year follow-up, with consequences such as eye-closing problems, excessive tear secretion, pronunciation difficulties and cosmetic complaints.
When cellular immune responses were investigated, the number of Borrelia-specific IL-4 and IFN-γ secreting cells in CSF was found to be more prominent in children with NB than in controls.
Furthermore, a much stronger IL-4 response in CSF was seen in children as compared to adults with NB. This cytokine profile of children with NB is believed to represent an effective and balanced type1/type2 response in a relevant compartment, and could contribute to the less severe course of the disease seen in children as compared to adults with NB.
No prognostic factors were found to influence the outcome in patients with ``Confirmed NB'' or facial nerve palsy. Nor was any specific cytokine profile, or antibody response to new Borrelia antigens in CSF, correlated to a less favorable clinical outcome.
An NB prediction score test, based on clinical features on admission, is suggested to help physicians to determine whether to start early antibiotic treatment, before results from Borrelia antibody tests are available.
Results in this thesis support the notion that mononuclear pleocytosis in CSF, in patients being evaluated for NB, indicates that they are true NB cases despite the fact that an antibody response cannot yet be visualized with the routine flagella test.
Consequently, early antibiotic treatment in NB seems to be the correct course of action and over-treatment is not a substantial problem.
..............................................
Let's hope that in the 5 year period before they get seen again by these so-called experts, the children will have been able to find out how to get completely better. What is this world coming to? Sweden has great wealth and one of the very highest standards of living in the world, but even they are following the IDSA.
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