Neurological manifestations of post-lyme syndrome: clinical features. Part 2

Neurological manifestations of post-lyme syndrome: clinical features. Part 2

N.S. Baranova, Y.S. Ostapenko, L.A. Ovsyannikova, N.N. Spirin, A.A. Baranov, M.A. Bykanova

Natalia S. Baranova, e-mail: baranova_ns@mail.ru

Yaroslavl State Medical University, Yaroslavl

Aim: to identify the clinical, epidemiological, and serological characteristics of post-Lyme syndrome (PLS) in different patient groups, depending on whether neurological symptoms developed or persisted after antibacterial therapy.

Materials and Methods: the study included 91 patients with a confirmed diagnosis of Lyme borreliosis and neurological symptoms present after antibiotic treatment. All patients underwent general clinical and neurological examinations, and epidemiological data were recorded. Serum IgM and IgG antibodies to Borrelia burgdorferi were measured by solid-phase enzyme-linked immunosorbent assay using the Anti-Borrelia ELISA test system. Cognitive function was assessed using Schulte tables and the Montreal Cognitive Assessment. Emotional status was evaluated using the Beck Depression Inventory, the Hospital Anxiety and Depression Scale (HADS), and the Multidimensional Fatigue Inventory (MFI-20).

Results: four patient groups were identified. In some patients, new neurological symptoms appeared after antibiotic therapy without further progression: these symptoms were predominantly subjective in group 1 — 47 patients (51.7%) — and clinically significant and progressive in group 2 — 25 patients (27.5%). In other patients, neurological symptoms had developed before treatment and persisted afterward, followed by partial regression in group 3 — 10 patients (10.9%) — or complete regression in group 4 — 9 patients (9.9%) — over 6 months of follow-up. Multiple and repeated tick bites were significantly more common in patients from groups 2 and 3. The predominant clinical manifestations across all groups were encephalopathy and radiculopathy, arthralgia and myalgia, and, less frequently, arthritis combined with neuropsychological disorders. These manifestations were significantly less severe in groups 1 and 4 than in groups 2 and 3. Serological testing detected both IgM and IgG antibodies to B. burgdorferi in all groups. IgM antibodies were significantly more frequent in group 3, which may indicate persistent or recurrent infection.

Conclusion: overall, insufficient efficacy of antibiotic therapy leading to PLS with the development or persistence of neurological symptoms may result from a combination of different mechanisms. Dysregulation of the immune response in PLS requires further investigation.

Keywords: Lyme borreliosis, post-Lyme syndrome, post-treatment Lyme disease syndrome, nervous system involvement.

For citation: Baranova N.S., Ostapenko Y.S., Ovsyannikova L.A., Spirin N.N., Baranov A.A., Bykanova M.A. Neurological manifestations of post-lyme syndrome: clinical features. Part 2. RMJ. 2026;6:21–26. DOI: 10.32364/2225-2282-2026-6-4