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Lyme Disease — Neurological TestsIgG and/or IgM WESTERN BLOT The Western blot should be considered for ultimate antibody sensitivity in the CSF. We use a 1:2 dilution of CSF (1:100 for serum) with longer incubation times to provide the required sensitivity. Because of concerns about leakage across the blood-brain barrier, these Western blots must be compared to recent blots of the patient's sera. ANTIGEN DETECTION B. burgdorferi antigen has been detected in CSF using the same antigen detection assay employed for urine. Clinical studies support the same cut-off value for urine and CSF. Patients with neurological symptoms of Lyme disease often have detectable antigen in their CSF. Antigen detection is a good assay to perform along with the multiplex PCR, as these antigen detection assays are occasionally complementary to one another.31 IGeneX,
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