Very little is known about tissue changes and pathophysiological mechanisms in Garin-Boujadoux-Bannwarth syndrome. We report histopathological findings in the central and peripheral nervous systems of three typical cases. In the acute stage of the disease mononuclear perivascular infiltrations with mainly T-helper cells were the prominent finding, whereas after treatment there was no vessel involvement. The fibre changes in the peripheral nervous system consisted of axonal degeneration. No Borrelia burgdorferi-specific antigen could be detected by immunohistochemical methods. Thus vasculitis might be one of the primary pathophysiological mechanisms for the involvement of the nervous system.

Follow‐up of 57 patients who suffered from antibiotically untreated acute, monophasic neuroborreliosis 5 to 27 years ago shows no significant difference in comparison with the follow‐up of 66 patients who suffered from antibiotically treated acute, monophasic neuroborreliosis during the last 5 years. In both groups, the involution of clinical symptoms and the normalization of pathological CSF findings were nearly identical. We found no significant difference of sequelae between the groups. Following acute neuroborreliosis, neither the antibiotically untreated nor the antibiotically treated patients developed chronic neuroborreliosis. Only in rare cases of primary chronic neuroborreliosis with CNS involvement did we observe convincing effects of antibiotics, which were given mostly in combination with glucocorticosteroids.

We report 5 cases with an extrapyramidal syndrome resulting from Borrelia burgdorferi encephalitis which responded to antibiotic treatment. The acute onset of extrapyramidal features together with diffuse pain can be the leading symptoms of central borreliosis.

Seventy-five patients with neurological symptoms of Lyme borreliosis were randomly assigned to intravenous treatment with either penicillin G or doxycycline. After 12 months the treatments were equally effective regarding the clinical picture and laboratory findings. No patient was considered to be a treatment failure. However, one-third of the patients showed delayed recovery, particularly after a longer primary disease duration. A slow recovery, lasting years, was typical of subacute or chronic borreliosis.

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