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To the Editor:
Blanc et al. found that a positive intrathecal anti-Borrelia antibody index (AI) had a low diagnostic sensitivity of 75% and a high specificity of 97% in Lyme neuroborreliosis.1 Based on this they suggest new diagnostic criteria, according to which patients with any neurologic symptom and a normal CSF lymphocyte count can be diagnosed with Lyme neuroborreliosis if they have either a positive AI or a response to antibiotic treatment given a negative history of neuroborreliosis and no differential diagnosis.
We have some concerns about both the reference standard used for definite neuroborreliosis and the suggested new diagnostic criteria. Our first concern is that 22 of the 40 patients classified as definite neuroborreliosis had a normal CSF lymphocyte count. Their clinical syndromes were cranial neuropathy, neuropathy, spinal radiculitis, acute delusion, cognitive impairment, lower motor neuron syndrome, and chronic polyradiculoneuritis. Could some of these syndromes be idiopathic with spontaneous recovery or placebo response to treatment? If Blanc et al. had used a stricter reference standard including presence of CSF pleocytosis, it would give a lower AI test specificity …
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