Practice parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology

J. J. Halperin, E. D. Shapiro, E. Logigian, A. L. Belman, L. Dotevall, G. P. Wormser, L. Krupp, G. Gronseth, C. T. Bever

Research output: Contribution to journalArticle

223 Citations (Scopus)

Abstract

OBJECTIVE: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? METHODS: The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. RESULTS: The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. CONCLUSIONS: There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (≥8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).

Original languageEnglish (US)
Pages (from-to)91-102
Number of pages12
JournalNeurology
Volume69
Issue number1
DOIs
StatePublished - Jul 2007

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Lyme Neuroborreliosis
Doxycycline
Nervous System
Neuritis
Radiculopathy
Cefotaxime
Ceftriaxone
Anti-Infective Agents
Meningitis
Penicillins
Therapeutics
Anti-Bacterial Agents
Infection

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Halperin, J. J. ; Shapiro, E. D. ; Logigian, E. ; Belman, A. L. ; Dotevall, L. ; Wormser, G. P. ; Krupp, L. ; Gronseth, G. ; Bever, C. T. / Practice parameter : Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. In: Neurology. 2007 ; Vol. 69, No. 1. pp. 91-102.
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abstract = "OBJECTIVE: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? METHODS: The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. RESULTS: The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. CONCLUSIONS: There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (≥8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).",
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Practice parameter : Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. / Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.

In: Neurology, Vol. 69, No. 1, 07.2007, p. 91-102.

Research output: Contribution to journalArticle

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AU - Halperin, J. J.

AU - Shapiro, E. D.

AU - Logigian, E.

AU - Belman, A. L.

AU - Dotevall, L.

AU - Wormser, G. P.

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AU - Gronseth, G.

AU - Bever, C. T.

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