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

@article{Halperin2007PracticePT,
  title={Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology},
  author={J. J. Halperin and Eugene D Shapiro and Eric L Logigian and Anita Lesgold Belman and Leif Dotevall and Gary P. Wormser and Lauren B. Krupp and Gary S. Gronseth and Christopher T. Bever},
  journal={Neurology},
  year={2007},
  volume={69},
  pages={102 - 91}
}
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… 

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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

A serious ethical problem is pointed out with the recently adopted Lyme disease treatment guidelines of the American Academy of Neurology and it is unacceptable to repackage the beleaguered guidelines of another medical society and allow overlapping panel members with clear conflicts of interest to control the process.

Lyme Disease: A Multisystem Infection That Affects the Nervous System

Infection with the tick‐transmitted spirochete Borrelia burgdorferi causes Lyme disease, a disorder that involves the nervous system in about 15% of patients, and it is likely that oral antibiotics are probably effective in patients with meningitis and other forms of involvement, with the likely exception of parenchymal CNS infection.

Nervous system lyme disease: is there a controversy?

  • J. Halperin
  • Medicine, Psychology
    Seminars in neurology
  • 2011
Persistent misconceptions about the role and interpretation of laboratory tests, what is and is not evidence of nervous system infection, and what constitutes an expected response to treatment have fostered widespread perceptions that this disease is highly controversial.

Nervous System Lyme Disease: Diagnosis and Treatment

  • J. Halperin
  • Medicine, Biology
    Current Treatment Options in Neurology
  • 2013
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.

Diagnosis and management of Lyme neuroborreliosis

  • J. Halperin
  • Medicine, Psychology
    Expert review of anti-infective therapy
  • 2018
There is no evidence that prolonged post-treatment neurocognitive symptoms are related to nervous system infection – either as a triggering event or as a cause of ongoing symptoms in patients infected with B. burgdorferi.

Neurologic Complications of Lyme Disease

This article reviews the symptomatology, diagnosis, and treatment of neuroborreliosis and concludes that the most common neurologic complications of Lyme disease are cranial neuritis, meningitis, and radiculoneuritis/mononeuropathy multiplex.

Diagnosis and treatment of the neuromuscular manifestations of Lyme disease

  • J. Halperin
  • Medicine, Biology
    Current treatment options in neurology
  • 2007
Treatment of nervous system infection typically consists of 2 to 4 weeks of parenteral ceftriaxone, cefotaxime, or high-dose penicillin (Class III), however, numerous European studies have shown that oral doxycycline is equally effective in patients with Lyme meningitis and cranial neuritis.

Oral treatment of parenchymal central nervous system neuroborreliosis – are we there yet?

Proof-of-principle evidence that oral antimicrobial therapy can be effective in the treatment of parenchymal central nervous system (CNS) neuroborreliosis is provided and two challenging dilemmas in treatment trials are illustrated – which patients are appropriately included and what metrics should be used to assess treatment response.

Nervous System Lyme Disease

  • J. Halperin
  • Medicine
    Current Infectious Disease Reports
  • 2014
Lyme disease, a multisystem spirochetal infection, continues to be the subject of considerable debate, but not controversy, and a rational approach based on objective findings can clarify the cause and dictate the best treatment of patients’ difficulties.

The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

These updated guidelines replace the previous treatment guidelines published in 2000 and list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided.
...

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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

A serious ethical problem is pointed out with the recently adopted Lyme disease treatment guidelines of the American Academy of Neurology and it is unacceptable to repackage the beleaguered guidelines of another medical society and allow overlapping panel members with clear conflicts of interest to control the process.

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