Risk of Neurological Disorders in Patients With European Lyme Neuroborreliosis: A Nationwide, Population-Based Cohort Study

Abstract Background Lyme neuroborreliosis (LNB), caused by the tick-borne spirochetes of the Borrelia burgdorferi sensu lato species complex, has been suggested to be associated with a range of neurological disorders. In a nationwide, population-based cohort study, we examined the associations between LNB and dementia, Alzheimer’s disease, Parkinson’s disease, motor neuron disease, epilepsy, and Guillain-Barré syndrome. Methods We used national registers to identify all Danish residents diagnosed during 1986–2016 with LNB (n = 2067), created a gender- and age-matched comparison cohort from the general population (n = 20 670), and calculated risk estimates and hazard ratios. Results We observed no long-term increased risks of dementia, Alzheimer’s disease, Parkinson’s disease, motor neuron diseases, or epilepsy. However, within the first year, 8 (0.4%) of the LNB patients developed epilepsy, compared with 20 (0.1%) of the comparison cohort (difference, 0.3%; 95% confidence interval, .02–.6%). In the LNB group, 11 (0.5%) patients were diagnosed with Guillain-Barré syndrome within the first year after LNB diagnosis, compared with 0 (0.0%) in the comparison cohort. After the first year, the risk of Guillain-Barré was not increased. Conclusions LNB patients did not have increased long-term risks of dementia, Alzheimer’s disease, Parkinson’s disease, motor neuron diseases, epilepsy, or Guillain-Barré. Although the absolute risk is low, LNB patients might have an increased short-term risk of epilepsy and Guillain-Barré syndrome. We examined the risk of neurological disorders in patients with Lyme neuroborreliosis. No increased long-term risk of neurological diseases was observed. Increased short-term risks of epilepsy and Guillain-Barré syndrome are likely to be caused by a diagnostic bias.