The diagnosis

The most important indication of a possible neuroborreliosis is a past tick bite. If the doctor is informed about such a bite and the patient shows typical symptoms of neuroborreliosis, cerebrospinal fluid (liquor) can be taken to confirm the diagnosis. For this purpose, a cannula is inserted into the spinal canal between the projections of the vertebral bodies on the back and some cerebrospinal fluid is drained.

This can then be examined in the laboratory. In the case of neuroborreliosis, the cerebrospinal fluid typically contains an increased amount of white blood cells that fight the infection. There is also an increased level of antibodies against the pathogen.

In some cases, it can be difficult to diagnose neuroborreliosis with certainty, as inflammation values in the cerebrospinal fluid are often not detectable, especially in the early stages. It can also take a while before antibodies are produced. In order to exclude other causes for the patient’s symptoms, imaging is often requested (e.g. CT, MRI of the brain).

If the brain itself is affected, imaging often reveals lesions similar to multiple sclerosis. The cerebrospinal fluid is the neural fluid that surrounds the brain and spinal cord. The cerebrospinal fluid is obtained during a lumbar puncture for CSF diagnostics.

In the case of neuroborreliosis, there are often indications of infection in the CSF, for example an increased number of white blood cells, an elevated level of antibodies against the pathogen Borrelia burgdorferi and sometimes elevated protein levels. Especially if the antibody level in the CSF is higher than in the blood, this is an indication of neuroborreliosis.Especially in the early stages of the disease, however, the changes in the cerebrospinal fluid can also be absent, so that cerebrospinal fluid diagnostics cannot be relied upon 100% with regard to the diagnosis. In neuroborreliosis, magnetic resonance imaging (MRI of the brain) can sometimes reveal changes.

For example, when the brain is affected, damage to the white matter of the brain is often revealed, which can look similar to that of multiple sclerosis (MS). If it is mainly the meninges that are affected, an accumulation of contrast medium can be observed there in imaging. To adequately distinguish neuroborreliosis from multiple sclerosis, different examinations and factors have to be considered.

These include differentiation from the disease circumstances, the complaints, findings, magnetic resonance imaging, electrophysiological examinations, CSF diagnostics, laboratory examinations, ophthalmological examinations, scletal scintigraphy and examinations of the heart. The onset of the disease in multiple sclerosis is between the age of 23-30 or 35-40, depending on the form. There may be a genetic predisposition.

Some authors suspect a relationship between infectious diseases and multiple sclerosis. Other authors may also imagine a connection to intestinal diseases. According to the current state of knowledge, the disease exclusively affects the central nervous system.

In contrast, neuroborreliosis can develop at any age. The trigger for neuroborreliosis is a tick bite. The risk of infection can vary due to individual and genetic factors.

The disease is not limited to the CNS but can manifest itself in other organs. The symptoms of neuroborreliosis and multiple sclerosis can be very similar. However, neuroborreliosis is usually accompanied by facial paralysis, inflammation of the heart muscle and other complaints and abnormalities of the heart, skin changes, damage to the liver, gastrointestinal tract, urogenital system, throat, lungs and sinuses.

In the case of multiple sclerosis, these symptoms do not normally manifest themselves. However, multiple sclerosis is characterized by the Charcot ́schen triad. All other symptoms are very similar, so that no differentiation can be made on the basis of the symptoms alone.

However, it is possible to distinguish the course of the disease. Multiple sclerosis is characterized by intervals with relapses and phases of remission. As a rule, the onset of the disease is sudden, within minutes or hours, or at most days.

However, multiple sclerosis can manifest itself weeks to months before the onset with unspecific complaints, such as fatigue, weight loss, general feeling of illness and muscle and joint pain. In contrast, neurological symptoms of acute neuroborreliosis develop more slowly within days. The decline in symptoms can last from weeks to years.

Residual symptoms and late damage may remain. In chronic neuroborreliosis, the symptoms are less pronounced than in the acute form. However, in contrast to multiple sclerosis, there are no completely symptom-free phases.

In magnetic resonance imaging, it is often not possible to detect significant differences. In CSF diagnostics, specific antibodies against Borrelia bacteria can sometimes be detected in neuroborreliosis. But if no antibodies are detectable, this is still not a safe exclusion criterion.

It is important to remember that the antibodies are not detectable until a few weeks after the event. However, certain signal proteins can be detected in the early stages of neuroborreliosis. In addition, further methods may reveal a typical picture in neuroborreliosis.

But even this is not always the case. In a very precise ophthalmological examination, the different eye complaints can sometimes be appropriately assigned to neuroborreliosis or multiple sclerosis. In a further examination, a scletal scintigraphy, nuclide accumulations in various joints can be detected in arthritis in the case of neuroborreliosis.

But even this cannot be used as a reliable single distinguishing feature. The heart can be examined with different methods. Multiple sclerosis usually does not cause heart problems.

On the other hand, in the case of neuroborreliosis, various restrictions and damage to the heart are not uncommon.To distinguish neuroborreliosis from multiple sclerosis, a comprehensive examination and several criteria are required. In order to reliably exclude or detect multiple sclerosis, the so-called McDonald criteria can be used. These describe the important characteristics of multiple sclerosis.