Key result
Neuroborreliosis was not associated with a higher number of white matter hyperintensity lesions, but patients exhibited a small reduction in lesion volume over 6 months compared to controls (median difference 0.136 ml).
Why the study?
White matter hyperintensities are widely considered important imaging findings in neuroborreliosis, but existing evidence regarding this association is of low quality.
Are white matter hyperintensities associated with neuroborreliosis?
Case-Control (n=139)
Yes
Are white matter hyperintensities associated with neuroborreliosis?
Mean Difference: 0.136 (95% CI 0.051–0.251)
Absolute Event Rate: 0.059% vs -0.057%
p-value: p=0.002
Non-specific white matter hyperintensities on brain MRI are not more numerous in patients with neuroborreliosis compared to healthy controls and should not be considered suggestive of the disease.
White matter hyperintensities should not suggest neuroborreliosis; leaves volume reduction hypothesis-generating in this Level 4 study.
PURPOSE: Many consider white matter hyperintensities (WMHs) to be important imaging findings in neuroborreliosis. However, evidence regarding association with WMHs is of low quality. The objective was to investigate WMHs in neuroborreliosis visually and quantitatively. MATERIALS AND METHODS: Patients underwent brain MRI within one month of diagnosis and six months after treatment. Healthy controls were recruited. WMHs were counted by visual rating and the volume was calculated from automatic segmentation. Biochemical markers and scores for clinical symptoms and findings were used to explore association with longitudinal volume change of WMHs. RESULTS: The study included 74 patients (37 males) with early neuroborreliosis and 65 controls (30 males). Mean age (standard deviation) was 57.4 (13.5) and 57.7 (12.9) years, respectively. Baseline WMH lesion count was zero in 14 patients/16 controls, < 10 in 36/31, 10-20 in 9/7 and > 20 in 13/11, with no difference between groups (p = 0.90). However, from baseline to follow-up the patients had a small reduction in WMH volume and the controls a small increase, median difference 0.136 (95% confidence interval 0.051-0.251) ml. In patients, volume change was not associated with biochemical or clinical markers, but with degree of WMHs (p values 0.002-0.01). CONCLUSION: WMH lesions were not more numerous in patients with neuroborreliosis compared to healthy controls. However, there was a small reduction of WMH volume from baseline to follow-up among patients, which was associated with higher baseline WMH severity, but not with disease burden or outcome. Overall, non-specific WMHs should not be considered suggestive of neuroborreliosis.
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Lindland et al. (2024) conducted a case-control in Neuroborreliosis (n=139). Neuroborreliosis vs. Healthy controls was evaluated on Change in white matter hyperintensity (WMH) volume from baseline to 6-month follow-up (MD 0.136, 95% CI 0.051-0.251, p=0.002). Neuroborreliosis was not associated with a higher number of white matter hyperintensity lesions, but patients exhibited a small reduction in lesion volume over 6 months compared to controls (median difference 0.136 ml).
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