When Lyme Neuroborreliosis Mimics Multiple Sclerosis. Challenges and Advances in Differential Diagnosis

Lyme neuroborreliosis (LNB) and multiple sclerosis (MS) are two separate entities that exhibit comparable neurological symptoms.1 LNB, a complication of Borrelia burgdorferi infection spread through tick bites, can present both acute (meningitis, radiculitis, cranial nerve palsy) and chronic (encephalopathy, polyneuropathy) neurological symptoms.2 MS, on the other hand, is an autoimmune demyelinating illness of the central nervous system that mainly affects young people. It is categorised into three types: Relapsing-Remitting MS (RRMS), Secondary Progressive MS (SPMS), and Primary Progressive MS (PPMS).3 Because of the overlapping features—such as paraesthesia, exhaustion, gait problems, cognitive impairment,1 and demyelinating lesions found on MRI4—the differential diagnosis is frequently complicated and may cause therapeutic delays.5,6 The classical diagnostic approach to LNB is based on clinical evaluation and detecting intrathecal Borrelia-specific antibodies.7 Conversely, MS is often diagnosed based on MRI demyelination patterns, the presence of CSF oligoclonal bands, and clinical evolution.8 However, both diseases may match some of these characteristics simultaneously, resulting in a misdiagnosis.1 The actual situation in Romania hampers diagnosis. The rising incidence of Lyme disease in this area, along with restricted access to modern CSF analyses, leads to both underdiagnosis and overtreatment.9 The purpose of this paper is to analyse and compare the diagnostic criteria for Lyme neuroborreliosis and multiple sclerosis, assess clinical and paraclinical overlap, and establish clear criteria for differential diagnosis between LNB and MS in terms of clinical manifestations, imaging techniques, and blood/cerebrospinal fluid (CSF) markers.