pubmed ... treatment of nervous system Lyme disease

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cave76
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pubmed ... treatment of nervous system Lyme disease

Post by cave76 » Sun 3 Feb 2008 3:11

Links
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 JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, Krupp L, Gronseth G, Bever CT Jr; Quality Standards Subcommittee of the American Academy of Neurology.

Department of Neurosciences, Overlook Hospital, NYU School of Medicine, Summit, NJ, USA.

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.

cave note------meta analysis!!!! Useless unless you want to massage data.

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 (> or =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).

PMID: 17522387 [PubMed - indexed for MEDLINE]

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LymeEnigma
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Re: pubmed ... treatment of nervous system Lyme disease

Post by LymeEnigma » Sun 3 Feb 2008 19:08

OBJECTIVE: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome.

...

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).
It would be nice if the researchers at least tried to delineate "post-Lyme" from "chronic Lyme" in their patients before conducting such a study, considering the possibility that not all chronic Lymies suffer from the same monster....

cave76
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Re: pubmed ... treatment of nervous system Lyme disease

Post by cave76 » Sun 3 Feb 2008 19:46

****It would be nice if the researchers at least tried to delineate "post-Lyme" from "chronic Lyme"***

It's semantics.

At this point---- no one can prove anything.

There's no clear demarcation.

There are no tests that even 'prove' if one has it or not--- with the possible exception of a PCR.

There are no tests that can 'prove' if one is 'over' acute Lyme or has drifted into post Lyme or another illness.

There may be---- some day in the future.

For now, I'll go with the 'best' and hope it works. If it doesn't, I'll go for the 'next best'.

I don't consider that (in my case) is synonymous with giving up or rolling over and playing dead.

I've just been cursed with an illness of some sort (MOST LIKELY TBI) that has done something awful to me.

And most likely it's bacterial in origin. Maybe viral. Maybe not.

I've been tested up, down and sideways for all sorts of things. And treated for 'all sorts of things'.

I'm better. That's all I know. But not 'good enough'.

Good luck in your endeavors. I don't mean that as dismissive. I really mean it. And when you find out 'what it is we all may suffer from'---- I hope you post it here.

As long as it doesn't mean drinking my urine or too many Reverse Latte's---- I'll jump on it.

Life is not perfect. And medical science certainly isn't.

rlstanley
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Re: pubmed ... treatment of nervous system Lyme disease

Post by rlstanley » Mon 4 Feb 2008 1:29

It would be nice if the researchers at least tried to delineate "post-Lyme" from "chronic Lyme" in their patients before conducting such a study, considering the possibility that not all chronic Lymies suffer from the same monster....
Chronic Lyme disease is considered 'highly implausable' by those who follow IDSA guidelines. Continuing symptomolgy is explained by being caused by a number of things, and post-Lyme is the one that is used RATHER than chronic. Chronic Lyme disease is not a term that these people use.

Go to IDSA GL's at http://www.journals.uchicago.edu/doi/fu ... 086/508667

THEN TO:

http://www.journals.uchicago.edu/doi/fu ... 508667#h40

Excerpts:
The notion that symptomatic, chronic B. burgdorferi infection can exist despite recommended treatment courses of antibiotics (tables 2 and 3) in the absence of objective clinical signs of disease, is highly implausible as evidenced by (1) the lack of antibiotic resistance in this genus [39, 40, 310], (2) the lack of correlation of persistent symptoms with laboratory evidence of inflammation or with the eventual development of objective physical signs [223, 257, 288, 289], and (3) the lack of precedent for such a phenomenon in other spirochetal infections [315–317]. Additional compelling evidence against the hypothesis that persistent symptoms are the result of persistent infection is the fact that the concentrations of antibodies against B. burgdorferi in many of these patients diminish to undetectable levels [257, 286, 288, 318]. The panel is unaware of any chronic infection in which antibody titers diminish despite persistence of the causative organism.
SNIP
The studies also show no evidence for recrudescence or persistence of clinical or histologic findings of an active inflammatory process consistent with B. burgdorferi infection when antibiotic‐treated animals are immunosuppressed [325, 327]. Therefore, even if a few residual B. burgdorferi spirochetes or their DNA debris persist after antibiotic treatment in animal systems, they no longer appear to be capable of causing disease.
Recommendations

1. There is no well‐accepted definition of post–Lyme disease syndrome. This has contributed to confusion and controversy and to a lack of firm data on its incidence, prevalence, and pathogenesis. In an attempt to provide a framework for future research on this subject and to reduce diagnostic ambiguity in study populations, a definition for post–Lyme disease syndrome is proposed in table 5. Whatever definition is eventually adopted, having once had objective evidence of B. burgdorferi infection must be a condition sine qua non. Furthermore, when laboratory testing is done to support the original diagnosis of Lyme disease, it is essential that it be performed by well‐qualified and reputable laboratories that use recommended and appropriately validated testing methods and interpretive criteria [117, 118]. Unvalidated test methods (such as urine antigen tests or blood microscopy for detection of Borrelia species) should not be used [337].
Table 5.
Proposed definition of post–Lyme disease syndrome.

Inclusion criteria

An adult or child with a documented episode of early or late Lyme disease fulfilling the case definition of the Centers for Disease Control and Prevention [112]. If based on erythema migrans, the diagnosis must be made and documented by an experienced health care practitioner.

After treatment of the episode of Lyme disease with a generally accepted treatment regimen [146] (tables 2 and 3), there is resolution or stabilization of the objective manifestation(s) of Lyme disease.
Onset of any of the following subjective symptoms within 6 months of the diagnosis of Lyme disease and persistence of continuous or relapsing symptoms for at least a 6 month period after completion of antibiotic therapy:

Fatigue
Widespread musculoskeletal pain
Complaints of cognitive difficulties
Subjective symptoms are of such severity that, when present, they result in substantial reduction in previous levels of occupational, educational, social, or personal activities.

Exclusion criteria


An active, untreated, well‐documented coinfection, such as babesiosis.

The presence of objective abnormalities on physical examination or on neuropsychologic testing that may explain the patient's complaints. For example, a patient with antibiotic refractory Lyme arthritis would be excluded. A patient with late neuroborreliosis associated with encephalopathy, who has recurrent or refractory objective cognitive dysfunction, would be excluded.

A diagnosis of fibromyalgia or chronic fatigue syndrome before the onset of Lyme disease.

A prolonged history of undiagnosed or unexplained somatic complaints, such as musculoskeletal pains or fatigue, before the onset of Lyme disease.

A diagnosis of an underlying disease or condition that might explain the patient's symptoms (e.g., morbid obesity, with a body mass index [calculated as weight in kilograms divided by the square of height in meters] 45; sleep apnea and narcolepsy; side effects of medications; autoimmune diseases; uncontrolled cardiopulmonary or endocrine disorders; malignant conditions within 2 years, except for uncomplicated skin cancer; known current liver disease; any past or current diagnosis of a major depressive disorder with psychotic or melancholic features; bipolar affective disorders; schizophrenia of any subtype; delusional disorders of any subtype; dementias of any subtype; anorexia nervosa or bulimia nervosa; and active drug abuse or alcoholism at present or within 2 years).

Laboratory or imaging abnormalities that might suggest an undiagnosed process distinct from post–Lyme disease syndrome, such as a highly elevated erythrocyte sedimentation rate (>50 mm/h); abnormal thyroid function; a hematologic abnormality; abnormal levels of serum albumin, total protein, globulin, calcium, phosphorus, glucose, urea nitrogen, electrolytes, or creatinine; significant abnormalities on urine analysis; elevated liver enzyme levels; or a test result suggestive of the presence of a collagen vascular disease.

Although testing by either culture or PCR for evidence of Borrelia burgdorferi infection is not required, should such testing be done by reliable methods, a positive result would be an exclusion.

2. To date, there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Antibiotic therapy has not proven to be useful and is not recommended for patients with chronic (6 months) subjective symptoms after administration of recommended treatment regimens for Lyme disease (E‐I).

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Re: pubmed ... treatment of nervous system Lyme disease

Post by LymeEnigma » Mon 4 Feb 2008 18:46

Sorry ... I meant for that to be taken rhetorically....

Nick
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Re: pubmed ... treatment of nervous system Lyme disease

Post by Nick » Mon 18 Feb 2008 15:31

rlstanley wrote:
Therefore, even if a few residual B. burgdorferi spirochetes or their DNA debris persist after antibiotic treatment in animal systems, they no longer appear to be capable of causing disease.
There is no scientific evidence at all for this statement. I suggest we test this on Mr. Halperin and friends as they seem to be very sure of their case (IMHO contrary to available evidence, especially from animal research).
Exclusion criteria
Although testing by either culture or PCR for evidence of Borrelia burgdorferi infection is not required, should such testing be done by reliable methods, a positive result would be an exclusion.
I guess those cases should qualify as chronic lyme then? I think there are many of these cases, at least in Europe. But probably they only accept 'reliable methods' from their own lab, to make sure no positives after 'accepted treatment' are ever found.
To date, there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Antibiotic therapy has not proven to be useful and is not recommended for patients with chronic (6 months) subjective symptoms after administration of recommended treatment regimens for Lyme disease (E‐I).
hilarious, first they say there is no evidence that chronic infection exists, and right after it they say antibiotic therapy does not work for these cases. Severe case of neuroborreliosis if you ask me :mrgreen:

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Re: pubmed ... treatment of nervous system Lyme disease

Post by Martian » Mon 18 Feb 2008 19:20

Nick wrote:hilarious, first they say there is no evidence that chronic infection exists, and right after it they say antibiotic therapy does not work for these cases. Severe case of neuroborreliosis if you ask me
Perhaps it is, perhaps it is not. It may seem like a contradiction, but it isn't. One could have chronic subjective symptoms that are not caused by chronic B. burgdorferi infection. Therefore, a distinction is made between "symptomatic chronic B. burgdorferi infection" and "chronic subjective symptoms".

itsy
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Re: pubmed ... treatment of nervous system Lyme disease

Post by itsy » Mon 18 Feb 2008 20:56

<i>The presence of objective abnormalities on physical examination or on neuropsychologic testing that may explain the patient's complaints. For example, a patient with antibiotic refractory Lyme arthritis would be excluded. A patient with late neuroborreliosis associated with encephalopathy, who has recurrent or refractory objective cognitive dysfunction, would be excluded.</i>

Confused...

If I still have arthritis after antibiotics and neuro complications (radiculitis, neuropathy, cognitive stuff, neck pain/stiffness, migraine) after almost a year of orals...If there is no chronic lyme and no post lyme if I have these symptoms...which do I have?

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Re: pubmed ... treatment of nervous system Lyme disease

Post by Nick » Thu 21 Feb 2008 11:18

Martian wrote:
Nick wrote:hilarious, first they say there is no evidence that chronic infection exists, and right after it they say antibiotic therapy does not work for these cases. Severe case of neuroborreliosis if you ask me
Perhaps it is, perhaps it is not. It may seem like a contradiction, but it isn't. One could have chronic subjective symptoms that are not caused by chronic B. burgdorferi infection.
first of all, why would you test antibiotic treatment if you already 'know' that there is no infection?

One could have chronic symptoms that are caused by a form of Bb that is resistant to antibiotic treatment (e.g. because of CWD/cyst form). If a symptom does not respond to AB treatment that does not rule out that there is an infection. Bb are NOT bacteria, most of the experience with antibiotics simply does not apply because we still know very little about spirochetes; yes, some treponemas get killed quicly with penicillin, but that is just one of many very diverse spirochete species. At least the slow growth and apparently pleomorphic nature of Bb should stop scientists from jumping to conclusions like these.

Nick
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Re: pubmed ... treatment of nervous system Lyme disease

Post by Nick » Thu 21 Feb 2008 11:19

itsy wrote: If I still have arthritis after antibiotics and neuro complications (radiculitis, neuropathy, cognitive stuff, neck pain/stiffness, migraine) after almost a year of orals...If there is no chronic lyme and no post lyme if I have these symptoms...which do I have?
yeah, I'm sure it is not (just) you that is confused :mrgreen:

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