Neuropsychological Profile of Children after an Episode of Neuroborreliosis

Abstract

Background In the majority of patients with Lyme neuroborreliosis (LNB), neurological symptoms are transient. The extent of neuropsychological and neuropsychiatric problems in children is not well researched.

Objectives The study aimed to investigate cognitive functions and behavioral problems in children after LNB.

Patients and Methods A total of 20 children between 6 and 16 years of age with an episode of LNB at least 4 month before neuropsychological testing were enrolled in the study and compared with 20 healthy controls. Children with LNB had cranial nerve palsies or meningoencephalitis, immunoglobulin G and immunoglobulin M antibodies for Borrelia burgdorferi in the peripheral blood, pleocytosis in the cerebrospinal fluid (leukocytes > 10 cells/μL) and/or an intrathecal synthesis of antibodies for B. burgdorferi.

Neuropsychological tests assessing intellectual skills, memory, and executive functions were used. Two parental questionnaires assessing behavior, psychiatric problems, and executive functions were administered.

Results Intellectual skills, memory, and executive functions of children after an episode of LNB were within the normal range. In the subcategory of working memory, children after an episode of LNB performed worse than controls. The questionnaires did not reveal behavior or psychiatric problems, although there was a tendency that children after an episode of LNB had more physical complaints.

Conclusion Neuropsychological deficits resulting from LNB in childhood are rare. Most children had a good cognitive, emotional, and behavioral outcome.

Keywords

children - neuropsychology - Lyme disease - long-term outcome - neurological manifestation

• References

• 1 Christen HJ. Lyme neuroborreliosis in children. Ann Med 1996; 28 (3) 235-240
• 2 Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am 1998; 21 (3) 693-703 , viii
• 3 Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med 1990; 323 (21) 1438-1444
• 4 Benke T, Gasse T, Hittmair-Delazer M, Schmutzhard E. Lyme encephalopathy: long-term neuropsychological deficits years after acute neuroborreliosis. Acta Neurol Scand 1995; 91 (5) 353-357
• 5 Krupp LB, Masur D, Schwartz J , et al. Cognitive functioning in late Lyme borreliosis. Arch Neurol 1991; 48 (11) 1125-1129
• 6 Svetina C, Barr WB, Rastogi R, Hilton E. The neuropsychological examination of naming in Lyme borreliosis. Appl Neuropsychol 1999; 6 (1) 33-38
• 7 Bloom BJ, Wyckoff PM, Meissner HC, Steere AC. Neurocognitive abnormalities in children after classic manifestations of Lyme disease. Pediatr Infect Dis J 1998; 17 (3) 189-196
• 8 Adams WV, Rose CD, Eppes SC, Klein JD. Long-term cognitive effects of Lyme disease in children. Appl Neuropsychol 1999; 6 (1) 39-45
• 9 Elkins LE, Pollina DA, Scheffer SR, Krupp LB. Psychological states and neuropsychological performances in chronic Lyme disease. Appl Neuropsychol 1999; 6 (1) 19-26
• 10 Vazquez M, Sparrow SS, Shapiro ED. Long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease. Pediatrics 2003; 112 (2) 93-97
• 11 Skogman BH, Glimåker K, Nordwall M, Vrethem M, Ödkvist L, Forsberg P. Long-term clinical outcome after Lyme neuroborreliosis in childhood. Pediatrics 2012; 130 (2) 262-269
• 12 Deutsche Gesellschaft für Neurologie [Internet]. Berlin [updated 2008]. Available at: http://www.dgn.org/inhalte-kapitel/442-leitlinien-der-dgn-neuroborreliose.html
• 13 Petermann F, Petermann U. Hamburg-Wechsler-Intelligenztest für Kinder IV (1. Auflage; HAWIK-IV). Göttingen, Germany: Hogrefe; 2007
• 14 Helmstadter C, Lendt M, Lux S. VLMT: Verbaler Lern- und Merkfähigkeitstest. Göttingen, Germany: Hogrefe; 2001
• 15 Spreen O, Strauß E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. New York, NY: Oxford University Press; 1991
• 16 Aschenbrenner S, Tucha O, Lange KW. Regensburger Wortflüssigkeitstest. Göttingen, Germany: Hogrefe; 2000
• 17 Regard M, Strauss E, Knapp P. Children's production on verbal and non-verbal fluency tasks. Percept Mot Skills 1982; 55 (3 Pt 1) 839-844
• 18 Tucha O, Lange KW. Turm von London – Deutsche Version. Göttingen, Germany: Hogrefe; 2004
• 19 Wechsler D. Wechsler Memory Scale—Revised. New York, NY: Psychological Corporation; 1987
• 20 Baron IS. Neuropsychological evaluation of the child. New York, NY: Oxford University Press; 2004
• 21 Achenbach TM. Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, VT: University of Vermont, Department of Psychiatry; 1991
• 22 Gioia GA, Isquith PK, Guy SC, Kenworthy L. Behavior Rating Inventory of Executive Functions (BRIEF). Florida: PAR Inc; 2000
• 23 Halperin JJ, Shapiro ED, Logigian E , et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007; 69 (1) 91-102
• 24 Tager FA, Fallon BA, Keilp J, Rissenberg M, Jones CR, Liebowitz MR. A controlled study of cognitive deficits in children with chronic Lyme disease. J Neuropsychiatry Clin Neurosci 2001; 13 (4) 500-507
• 25 McAuliffe P, Brassard MR, Fallon B. Memory and executive functions in adolescents with posttreatment Lyme disease. Appl Neuropsychol 2008; 15 (3) 208-219
• 26 Fallon BA, Nields JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry 1994; 151 (11) 1571-1583
• 27 Fallon BA, Nields JA, Burrascano JJ, Liegner K, DelBene D, Liebowitz MR. The neuropsychiatric manifestations of Lyme borreliosis. Psychiatr Q 1992; 63 (1) 95-117
• 28 Skogman BH, Croner S, Nordwall M, Eknefelt M, Ernerudh J, Forsberg P. Lyme neuroborreliosis in children: a prospective study of clinical features, prognosis, and outcome. Pediatr Infect Dis J 2008; 27 (12) 1089-1094
• 29 Haass A. Lyme neuroborreliosis. Curr Opin Neurol 1998; 11 (3) 253-258