1: Curr Treat Options Neurol. 2005 Mar;7(2):167-170. Related Articles,
Links

The Therapy of Lyme Neuroborreliosis.

Pachner AR.

Department of Neurology, UMDNJ-New Jersey Medical School, 185 South

The challenge for the neurologist in the treatment of Lyme
neuroborreliosis is not in the treatment per se, but in the diagnosis.
Neurological manifestations of Lyme disease can present in many forms,
and diagnostic techniques which detect the spirochete directly; the
culture or polymerase chain reaction of the spirochete in cerebrospinal
fluid, are of disappointingly low yield. Therefore, the diagnosis is
frequently not easy. After the diagnosis is made, antibiotic therapy is
straightforward; Lyme neuroborreliosis should be treated with at least
2 weeks of antibiotics. In the United States, intravenous therapy with
ceftriaxone or penicillin for 2 weeks is the standard, whereas in
Europe {*filter*}doxycycline therapy is commonly administered. Either is
effective, and my choice of therapy generally depends on the patient.
Many patients have symptoms which continue after antibiotic therapy
referable to persistent inflammation, and, for those patients, I will
commonly prescribe nonsteroidal anti-inflammatory medications.

PMID: 15676120 [PubMed - as supplied by publisher]

Persistant inflamation---Gee, he's right ..... I am pissed off at the
Steere guys all the time.

this is a very questionable paper. both halperin and pachner have
become the leading proponents in the US for using {*filter*}doxy to treat
neuroborreliosis, although to my knowledge there has never been a
controlled trial using doxy against the genospecies seen in the US
which is sensu stricto. outside of the klempner trial, that is, which
demonstrated that {*filter*}doxy was not effective, although they used such
a minimal dose that it is hard to draw any definite conclusions.

essentially these individuals are reporting anecdotal success with {*filter*}
doxy, or relying on european reports which involve azfelii or garinii.
this is the exact same type of logic which the steerites have heavily
criticized when LLMDs have called for long term abx treatment.

I have never met a patient or heard of an individual who was cured of
late stage Bb s.s. neuroborreliosis by doxycycline alone. furthermore,
steere himself has stated more than once in published papers over the
past 3 years that {*filter*}doxy may not be effective or has not been
effective in his experience in treating neuroborreliosis.

the conclusion of pachner, which is that post treatment symptomology is
due to persistent inflammation, is probably erroneous. his conclusion
that {*filter*}doxy "works" in these patients is highly questionable...if
they are experiencing continued symptoms, it very likely is NOT
working.

Fallon should do one more treatment trial, at least, and this one
should be similar to the one he just finished, perhaps using smaller
numbers of patients, and compare the effects of 10 weeks of ceftriaxone
to the effects of patients treated with {*filter*}doxy of the klempner level
compared to a control group, and follow very closely with spect and pet
scanning. it might also be interesting to compare these patients to
similarly treated groups of european patients.

this would possibly be a "nail in the coffin" study wrt all this {*filter*}
doxy garbage.