Nervous system lyme disease

Diagnosis and treatment

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Opinion statement: The tick-borne spirochete responsible for Lyme disease is highly antibiotic-sensitive. Treatment related misconceptions can be attributed to confusion in three principal realms: (1) the appropriate approach to diagnosis (who should be treated); (2) necessary and appropriate treatment; and (3) what actually constitutes nervous system infection and to what extent this mandates different treatment. Contrary to often-repeated assertions, laboratory-based diagnosis - in the appropriate setting - is as valid as it is in most other serologically diagnosed infections. Treatment is highly effective in the vast majority of patients, including those with nervous system disease. Nervous system infection, most typically meningitis, cranial neuritis, radiculoneuritis, and other forms of mononeuropathy multiplex, is highly antibiotic responsive. The encephalopathy that can be seen in some patients with active infection represents the same phenomenon that occurs in patients with many other inflammatory disorders, is not evidence of central nervous system (CNS) infection, and does not require any different, more prolonged, or more intensive treatment. In patients with infection not involving the CNS, oral treatment with amoxicillin, cefuroxime axetil, or doxycycline for 2-4 weeks is almost always curative. Despite historic preferences for parenteral treatment with ceftriaxone, cefotaxime, or meningeal dose penicillin, patients with the forms of nervous system involvement listed above are highly responsive to oral doxycycline. Parenteral regimens can be reserved for those very rare patients with parenchymal CNS involvement, other severe forms of infection, or the approximately 5 % of patients who fail to respond to oral regimens.

Original languageEnglish (US)
Pages (from-to)454-464
Number of pages11
JournalCurrent Treatment Options in Neurology
Volume15
Issue number4
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Lyme Neuroborreliosis
Infection
Nervous System
Doxycycline
cefuroxime axetil
Therapeutics
Central Nervous System
Mononeuropathies
Anti-Bacterial Agents
Neuritis
Central Nervous System Infections
Borrelia burgdorferi
Cefotaxime
Ceftriaxone
Clinical Laboratory Techniques
Amoxicillin
Brain Diseases
Ticks
Nervous System Diseases
Meningitis

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

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abstract = "Opinion statement: The tick-borne spirochete responsible for Lyme disease is highly antibiotic-sensitive. Treatment related misconceptions can be attributed to confusion in three principal realms: (1) the appropriate approach to diagnosis (who should be treated); (2) necessary and appropriate treatment; and (3) what actually constitutes nervous system infection and to what extent this mandates different treatment. Contrary to often-repeated assertions, laboratory-based diagnosis - in the appropriate setting - is as valid as it is in most other serologically diagnosed infections. Treatment is highly effective in the vast majority of patients, including those with nervous system disease. Nervous system infection, most typically meningitis, cranial neuritis, radiculoneuritis, and other forms of mononeuropathy multiplex, is highly antibiotic responsive. The encephalopathy that can be seen in some patients with active infection represents the same phenomenon that occurs in patients with many other inflammatory disorders, is not evidence of central nervous system (CNS) infection, and does not require any different, more prolonged, or more intensive treatment. In patients with infection not involving the CNS, oral treatment with amoxicillin, cefuroxime axetil, or doxycycline for 2-4 weeks is almost always curative. Despite historic preferences for parenteral treatment with ceftriaxone, cefotaxime, or meningeal dose penicillin, patients with the forms of nervous system involvement listed above are highly responsive to oral doxycycline. Parenteral regimens can be reserved for those very rare patients with parenchymal CNS involvement, other severe forms of infection, or the approximately 5 {\%} of patients who fail to respond to oral regimens.",
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Nervous system lyme disease : Diagnosis and treatment. / Halperin, John.

In: Current Treatment Options in Neurology, Vol. 15, No. 4, 01.08.2013, p. 454-464.

Research output: Contribution to journalArticle

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