[85]. Keywords: Borrelia burgdorferi infection, Lyme borreliosis, Lyme disease, Bannwarths syndrome, lymphocytic meningoradiculitis, facial palsy, polyradiculitis, meningitis, encephalomyelitis, polyneuropathy, ixodid tick-borne borreliosis Zusammenfassung Die Lyme-Borreliose ist die h?ufigste durch Zecken bertragene BCR-ABL-IN-2 Infektionskrankheit in Europa. Eine neurologische Manifestation kommt bei 3C15% der Infektionen vor und kann sich als Polyradikulitis, Meningitis sowie selten als Enzephalomyelitis manifestieren. Die Erkrankung ist durch Antibiotika behandelbar. Diese S3-Leitlinie richtet sich an ?rzte in Praxis und Klinik, die mit der Behandlung der Neuroborreliose bei Kindern und Erwachsenen befasst sind. An der Entwicklung waren 20 AWMF-Mitgliedsgesellschaften, das Robert Koch-Institut, die Deutsche Borreliose-Gesellschaft und 3 Patientenorganisationen beteiligt. Die systematische Literaturrecherche und Literaturbewertung wurden durch das Deutsche Cochrane Zentrum Freiburg (Cochrane Deutschland) durchgefhrt. Hauptziele der Leitlinie sind es, die Krankheit zu definieren und Empfehlungen abzugeben zur Best?tigung der Verdachtsdiagnose mittels Laboruntersuchungen, Antibiotikabehandlung, Differenzialdiagnostik und Pr?vention. Preamble This guideline pertains to the diagnosis and treatment of neurological manifestations of Lyme borreliosis in children and adults. In the future it will be integrated as module 2 of the planned interdisciplinary S3 guideline Lyme Borreliosis C Diagnosis and Treatment, AWMF Register No. 013-080. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany) with significant input from Dr. Rick Dersch. The interdisciplinary guideline group is currently developing the S2k guideline Cutaneous Lyme Borreliosis (AWMF Register No. 013-044) [1] into an S3 guideline with the aim BCR-ABL-IN-2 of modularly integrating it into the interdisciplinary guideline. Part 3 Lyme Arthritis, Lyme Carditis and Other Rare Manifestations will then be developed as a further module of the interdisciplinary S3 guideline Lyme Borreliosis BCR-ABL-IN-2 C Diagnosis and Treatment. The guideline was formally adopted by the boards of the participating organisations with the exception of the DBG and the patient organisations BFBD, BZK and OnLyme-Aktion.org. The DBG and the patient organisations BFBD, BZK and OnLyme-Aktion.org have issued statements of dissent, which are published in an appendix (Attachment 1 ) to the guideline report (Attachment 2). Whats new? The previous S1 guideline on Lyme neuroborreliosis (AWMF Register No. 030-071) [2] has been developed into an S3 guideline on Lyme neuroborreliosis according to the BCR-ABL-IN-2 methodological guidelines of the Association of Scientific Medical Societies (AWMF). The validity of the guideline has been extended to include the diagnosis and treatment of Lyme neuroborreliosis in children based on a systematic review [3]. A systematic review of antibiotic treatment of Lyme neuroborreliosis in adults [4] found MGC4268 the following: There is no scientific basis for deviating from the previously recommended treatment duration of 14 days for early and 14C21 days for late Lyme neuroborreliosis. In the case of early Lyme neuroborreliosis, doxycycline and beta-lactam antibiotics (penicillin G, ceftriaxone and cefotaxime) are equally effective in terms of the regression of neurological symptoms and are tolerated equally. There are no reliable, analysable study data on the efficacy of combination antibiotic therapy. There are no study data available on the efficacy of chloroquine, carbapenems and metronidazole. A systematic review has found that the high prevalence of persisting non-specific and/or atypical symptoms following Lyme neuroborreliosis, as reported in many studies, can largely be traced to study artefacts resulting from imprecise case definitions [5]. Key recommendations A suspected clinical diagnosis of neuroborreliosis (cranial nerve deficits, meningitis/meningoradiculitis, encephalomyelitis) can be confirmed by the detection of inflammatory changes in cerebrospinal fluid linked to Borrelia-specific intrathecal antibody synthesis. Serological testing should only be conducted if there is sufficient clinical suspicion. (consensus 10/13) The following antibiotics should be used to treat early and late Lyme neuroborreliosis: doxycycline, ceftriaxone, cefotaxime, penicillin G. (consensus 9/13) Antibiotic treatment should last 14 days (early.