Vol.:(0123456789) 1 3 Journal of Neurology https://doi.org/10.1007/s00415-019-09359-0 ORIGINAL COMMUNICATION Neuronal loss or dysfunction in patients with early Lyme neuroborreliosis: a proton magnetic resonance spectroscopy study of the brain Adam Garkowski 1  · Bożena Kubas 2  · Marcin Hładuński 2  · Joanna Zajkowska 3  · Olga Zajkowska 4  · Dorota Jurgilewicz 2  · Radosław Zawadzki 1  · Ewa Garkowska 1  · Sławomir Pancewicz 3  · Urszula Łebkowska 1 Received: 21 January 2019 / Revised: 8 April 2019 / Accepted: 3 May 2019 © The Author(s) 2019 Abstract Background We hypothesized that since Borrelia burgdorferi causes systemic infammation and infects the brain, it may lead to alterations in cerebral metabolism, as measured by 1 H-magnetic resonance spectroscopy ( 1 H-MRS). The purpose of our study was to determine whether 1 H-MRS could detect brain metabolite alterations in patients with early Lyme neurobor- reliosis (LNB) in normal-appearing brain tissue on the conventional magnetic resonance imaging (MRI). Methods Twenty-six patients diagnosed with early LNB and twenty-six healthy volunteers as a control group have been involved in the study. All of them underwent routine MRI protocol using 3.0-T MRI scanner. 1 H-MRS examinations were performed with repetition time (TR) = 2000 ms, and echo time (TE) = 135 ms. Single voxels were positioned in the anterior and posterior parts of the right and left frontal lobes. Results We found a statistically signifcant decrease of the N-acetylaspartate/creatine ratio within the anterior part of the right and left frontal lobes (p ≤ 0.001 and p = 0.001 respectively) and in the posterior part of the right and left frontal lobes (p ≤ 0.001 and 0.031) in the patients with LNB. Conclusion A signifcant reduction in NAA/Cr ratio in comparison with the controls suggests the presence of difuse neu- ronal loss in patients with early LNB. Keywords Lyme neuroborreliosis · Borrelia burgdorferi · 1 H-magnetic resonance spectroscopy,1H-MRS · Magnetic resonance spectroscopy Introduction Lyme borreliosis (or Lyme disease) is a tick-transmitted multisystem infammatory disease caused by the spirochete Borrelia burgdorferi sensu lato genospecies complex, and is the most common arthropod-borne disease in temperate regions of the northern hemisphere. In Europe, this dis- ease afects approximately 65,500 patients annually. Lyme neuroborreliosis (LNB) is a disease of the nervous system, occurring in 10–15% of all Lyme borreliosis cases, and can occur at any stage of the disease, and may afect both the central (CNS) and peripheral nervous system. LNB is more common in Europe than in the United States, and typically manifests as Bannwarth’s syndrome including lymphocytic meningitis, cranial neuritis, and radiculoneuritis. These manifestations can occur separately or together [1, 2].The direct symptoms of CNS involvement vary widely, and may result, e.g., in symptoms such as a headache, difculty with concentration, mood swings, disturbance of consciousness or Parkinson-like symptoms, and cerebrovascular complica- tions like stroke caused by cerebral vasculitis [2, 3]. It is known that B. burgdorferi has a tropism for the meninges in the CNS and for connective tissues elsewhere in the body. Autopsy brain studies on patients with LNB * Adam Garkowski adam.garkowski@gmail.com 1 Department of Radiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland 2 Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland 3 Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland 4 Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences SGGW, Warsaw, Poland