The value of CSF examinations for intrathecal antibody production to Borrelia burgdorferi in the diagnosis of neuroborreliosis in children with peripheral facial palsy (PFP) was examined at the University Children’s Hospital of Zurich, Switzerland. Twenty (95%) of the children with PFP had immunoglobulin (Ig)M or IgG in the acute-phase serum, but serologic assays showed discrepancies in one third. Intrathecal antibody to B. burgdorferi was present in 5 of the 20 seropositive children. Seroconversion in convalescent sera was found in all 5 with intrathecal antibody, and in 8 of 10 without intrathecal specific-antibody production. Patients showing intrathecal antibodies or seroconversion had lymphocytic pleocytosis in the acute phase of PFP. [1]

COMMENT. Analysis of CSF for intrathecal specific antibodies to B. burgdorferi in children presenting with acute peripheral facial palsy may facilitate early diagnosis and prompt antibiotic treatment. In patients with lymphocytic pleocytosis but no intrathecal antibodies, detection of seroconversion by analysis of convalescent serum is important in diagnosis.

Neurologic signs and syndromes associated with Lyme disease in children are reviewed in three reports and commentaries in Progress in Pediatric Neurology III, PNB Publishers, 1997;pp484-5. In one series of 96 patients, facial palsy occurred in 14%. Pseudotumor, reviewed in the following report, was diagnosed in 6% of cases of Lyme disease.