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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 - Source: Neurology, July 3, 2007

  [ 305 votes ]   [ 29 Comments ]
By JJ Halperin, et al. • www.ProHealth.com • September 7, 2007


[Note: It is ProHealth's policy to reprint the abstracts of research reported in reputable scientific journals. Our commitment is to keep the patient community informed about what is being published on pertinent subjects - unedited. We also believe it is important and valuable for readers to comment and share their thoughts on these reports, because this is what the scientific community is reading.] 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:

n 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).

n Although most studies have used parenteral [by injection or infusion] 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 Central Nervous System involvement, other severe neurologic symptomatology, or failure to respond to oral regimens.

n 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.

n In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).

Source: Neurology. 2007 Jul 3;69(1):91-102. PMID: 17522387, by 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.





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Article Comments Post a Comment

Halperin article
Posted by: dontlikeliver
Sep 7, 2007
Posting this article seriously makes me wonder if you are trying to PREVENT people from getting well. pathetic.
Reply Reply

 
Agree with DLL
Posted by: teach6
Sep 7, 2007
I agree with DLL. I personally know of many people who have improved using long-term abx treatment protocols.

Personally, my health has improved over the past 17 months of my Lyme treatment with abx.

This article is yet another example of findings which exclude the bulk of research, using only the studies that support their theory.

 


1 star
Posted by: gwen54
Sep 7, 2007
check the sources of this article...not exactly trustworthy. they should take their hands of of the insurance companies' pockets and use them to flip through some ILADS research....but first they would have to actually want to help patients (gasp!) rather than make a few bucks.
Reply Reply

 
Conflict of Interest in Halperin Guidelines
Posted by: tgrimes
Sep 9, 2007
The Halperin/Neurology Lyme guidelines were put together by the same people who put together the Infectious Disease Lyme guidelines, and these two guidelines are being called "independent". This is a clear conflict of interest at best. At worst it is an illegal, devious practice for both the Neurology and ID groups. Both groups' guidelines should be retracted.

 


Very Disappointing
Posted by: Aniek
Sep 7, 2007
This article fails to really be an objective, evidence based overview of Lyme diagnosis and treatment. There is a lack of evidence around treatment in Lyme Disease. That does not mean that we should follow the lowest treatment option available. They base their decision that longterm antibiotic treatment does not work on one study that used 3 months of one antibiotic protocol. This study included many patients with prior treatment failures. The truth is there are two standards of care for Lyme Disease. Patients have the right to be informed about both options and choose between short term treatment and longterm treatment.
Reply Reply

Halperin Article
Posted by: Beverly2343
Sep 7, 2007
Long term antibiotics do help Lyme Disease, my brain SPECT scan done at Columbia Presbyterian Medical Center in New York City, went from Moderate Global Cortical Hypoperfusion with Heterogeneity, to Mild Global Cortical Hypoperfusion with Heterogeneity. It took 3 years, but the antibiotics did help. Your statement is false. I rate your article 0
Reply Reply

 
RATING
Posted by: frankenstein
Sep 8, 2007
SOUNDS LIKE A VERY FAIR RATING TO ME!!

 


Halperin Article
Posted by: Lymeblue
Sep 7, 2007
It is a shame how this people insist over and over on this Post Lyme syndrome when is well known that long term antibiotics help patients significantly, therefore proving it is a persistent active infection and not an "autoimmune syndrome". They don't even mention Lyme disease co-infections at all, it is again, a shame....
Reply Reply

 
SUCKS
Posted by: frankenstein
Sep 8, 2007
SUCKS

 


halperin article
Posted by: tennis2764
Sep 7, 2007
this is old stuff from halperin and his friends. yes long term antibiotics worked for me and many others this article is bad. Why are they hiding this information you must ask yourself. If you need more information on this stuff please email me. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Department of Medicine, State University of New York, School of Medicine, Stony Brook 11794-8161. The diagnosis of Lyme disease often depends on the measurement of serum antibodies to Borrelia burgdorferi, the spirochete that causes this disorder. Although prompt treatment with antibiotics may abrogate the antibody response to the infection, symptoms persist in some patients. We studied 17 patients who had presented with acute Lyme disease and received prompt treatment with oral antibiotics, but in whom chronic Lyme disease subsequently developed. Although these patients had clinically active disease, none had diagnostic levels of antibodies to B. burgdorferi on either a standard enzyme-linked immunosorbent assay or immunofluorescence assay. On Western blot analysis, the level of immunoglobulin reactivity against B. burgdorferi in serum from these patients was no greater than that in serum from normal controls. The patients had a vigorous T-cell proliferative response to whole B. burgdorferi, with a mean ( +/- SEM) stimulation index of 17.8 +/- 3.3, similar to that (15.8 +/- 3.2) in 18 patients with chronic Lyme disease who had detectable antibodies. The T-cell response of both groups was greater than that of a control group of healthy subjects (3.1 +/- 0.5; P less than 0.001). We conclude that the presence of chronic Lyme disease cannot be excluded by the absence of antibodies against B. burgdorferi and that a specific T-cell blastogenic response to B. burgdorferi is evidence of infection in seronegative patients with clinical indications of chronic Lyme disease. PMID: 3054554 [PubMed - indexed for MEDLINE]
Reply Reply

halperin
Posted by: DaphneA
Sep 7, 2007
I am surprised that a "pro" health board would cite this biased work. There is too much evidence from ILADS, and from earlier works of IDSA guideline writers showing evidence of persistent infection and short term treatment failure. If you were interested in balance, not bias, there would be ILADS guidelines here, too. And an objective discussion. I rated this as a 1, since there was no lower digit available. DaphneA
Reply Reply

 
"I rated this as a 1, since there was no lower digit available. "
Posted by: frankenstein
Sep 8, 2007
Ditto.

 


halperin report
Posted by: kelmo
Sep 7, 2007
How short-sighted to say that there is no evidence that long term antibiotic use helps "post lyme syndrome". First of all, there is no such thing as "post lyme syndrome". You either have Lyme or you don't. If Lyme is not treated immediately for an amount of time not to detect infection, then you are infected in nearly every organ of your body with a handful of viruses and bacteria that break down your immune system. My daughter was diagnosed with CFS/FM after a year of being bounced from one specialist to another as each body system became infected and issues arose. Each "specialist" gave her a syndrome according to their speciality. However, there was a point of initial illness that our doctor treated with two weeks of doxycycline, then deemed her healed. The blood work showed persistent infection, but, by golly, if the book says two weeks, that's all your gonna get! Not one of those specialists tested for Lyme and co-infections because we live in the desert and "Lyme doesn't exist out here". Newsflash! Now, after two years of diabling pain, she has been on 18 months of different combinations of antibiotics to treat each organism eating up her body. After 18 months, many symptoms are gone, she is attending school on a limited basis. We are in the middle of treatment, and we are not stopping now! Would you tell a cancer patient that one month of chemo will clear those bad little cancer cells? Would you tell someone who is HIV positive that six months of their drug cocktail will free them to now have unprotected sex? Post AIDS syndrome? I don't understand how you can make such a blanket statement without doing research on all sides of this story. You would rather condemn my daughter to a lifetime of treating symptoms, than a few years of treating the disease! Shame on you!
Reply Reply

Hogwash.
Posted by: michellemahood
Sep 7, 2007
Are you people aware that the drafters of the IDSA Guidelines for treatment of lyme are UNDER INVESTIGATION by the Connecticut Attorney General for antitrust violations and conflicts of interest? It's truly as if you don't want your subscribers to find out they might have lyme (as many likely do). I suppose that would dry up a lot of subscriptions and sales. There are DOZENS of peer-reviewed studies documenting the persistence of the lyme bacteria in spite of repeated courses of antibiotics! All these studies were summarily ignored in formulating the Guidelines. Read, people, READ!! Start in PubMed. Chronic fatigue and fibromyalgia are frequently misdiagnoses of lyme infection. Tests your doctors have likely used to "rule out" lyme such as the ELISA are up to 50% or more inaccurate. Common co-infections are a complete mystery to doctors not knowledgeable in lyme disease, but can be as disabling as lyme itself. Here's some places to start getting educated. It's a shame the doctors themselves won't read it but they prefer the IDSA Guidelines since it saves them a lot of time and ensures their patients will stick around indefinitely. Bacterial persistence in lyme disease -- A primer: http://www.lymesite.com/scientific%20proof%20of%20chronic%20Lyme.htm http://www.lymediseaseaction.org.uk/articles/persistence.htm http://www.lymesite.com/scientific%20proof%20of%20chronic%20Lyme.htm http://lymerick.ulmarweb.dk/persistent-borreliosis.htm
Reply Reply

 
Good info, Michelle!!
Posted by: frankenstein
Sep 8, 2007
For ACCURATE testing, go to www.igenex.com

 


Shame on you (Halperin article)
Posted by: NotFMSorCFS
Sep 8, 2007
By posting an article like this, you are telling your community lies. I would guess that a majority of your community, if not ALL, have "late" or "chronic" Lyme and need to start treatment immediately. You not only did not do your community any favors, but you kept them from being helped some day. Some people WANT to get well, they don't want to sit around feeling sorry for themselves that they are so sick. I never stopped looking for help. At Mayo, they told us to stop seeing doctors, just admit to ourselves that we have Fibro and live with it. Thank goodness I didn't listen. And your readership should not listen to you. People, if you have not considered Lyme, please look at it now. If you have questions, please visit us at www.lymenet.com and ask any question you desire. Please. I want to help other FMS/CFS sufferers the way I was helped (a woman in the guai protocol forum told me that her FMS was caused by Lyme). I have since found that woman and thanked her for saving my life.
Reply Reply

 
LYME help
Posted by: frankenstein
Sep 8, 2007
www.lymenet.org Look for "flash discussion" at the bottom of the page

 


Garbage
Posted by: pjsmonster
Sep 8, 2007
This is complete garbage and should be removed from this site which usually provides very good information.
Reply Reply

 
IDSA
Posted by: frankenstein
Sep 8, 2007
NEVER EVER TRUST THE idsa! THEY ARE TRYING TO KEEP life saving treatments from the chronically ill!!!!

 


This is Shamful
Posted by: anajean42
Sep 8, 2007
It is shameful that this article minimizes the horrible tragedies and complications of Lyme Diese. I wonder why these people want to keep us sick. I call it one hand feeding the other. It is all politics. It stinks!! Shame! Shame! Shame! anajean42
Reply Reply

Conflict of Interest in Halperin Guidelines
Posted by: tgrimes
Sep 9, 2007
The Halperin/Neurology Lyme guidelines were put together by the same people who put together the Infectious Disease Lyme guidelines, and these two guidelines are being called "independent". This is a clear conflict of interest at best. At worst it is an illegal, devious practice for both the Neurology and ID groups. Both groups' guidelines should be retracted.
Reply Reply

deserves a zero star rating
Posted by: Victoria
Sep 9, 2007
Printing this without any companion article or link regarding the opposite viewpoint is irresponsible at best. In fact, I am shocked that you did not indicate there IS a well-documented basis for an opposite viewpoint for those new to the symptoms and mysteries of the "syndrome/disease/whatever you want to call it" that get lumped into "autoimmune disorders" of all names, be it CFIDS, FM, ME, MS, etc. The Academy of Neurology, and the IDSA in particular, are very upset with patient advocates, preferring the attitude that the 'lay public' cannot make responsible conclusions or decisions for themselves. The IDSA has been quoted in many news articles implying that the opposite viewpoint is driven by "patient advocacy", thus trying to dismiss us as if we and our doctors are deluded, that there is no basis for such treatment, and that such advocacy is wrong and to be ignored. So, considering that ProHealth/ImmuneSupport was founded by Rich Carson, a "patient advocate" himself who has helped the community of CFIDS/FM/ME with being taken seriously, I find it strange that ProHealth did NOT indicate there is a very strong case for the opposite conclusion, that Chronic Lyme/Neuroborreliosis and prolonged treatment for Lyme can help. The very least this site could do is to refer people to the ILADS.org site to read the opposite viewpoint; better would be to print ILAD's president's rebuttal to this article and the IDSA's position. Lastly, you should give an alternative 'zero star' rating for us to choose, as the presentation of this article deserves it. Victoria
Reply Reply

 
IDSA MDs did research showing opposite
Posted by: Victoria
Sep 9, 2007
The following was posted by Lymelite7 at http://www.washingtonpost.com/wp-dyn/content/article/2007/05/14/AR2007051401002_Comments.html

in response to a Washington Post article written by a freelancer, who also quoted Dr. Wormser as saying Lyme patient advocates were "too loud", to add insult to injury:

--However, these "experts" themselves have been on the forefront of publishing medical studies documenting the survival of the Lyme bacteria past multiple rounds of antibiotics. In 1992 and 1993, Mark Klempner published two studies in the Journal of Infectious Diseases documenting how Lyme "spirochetes can survive antibiotic treatment through intracellular sequestion within fibroblasts" making them "among the small number of bacteria that can cause chronic infection by localizing within host cells where they remain sequestered from some antimicrobial agents" (1993; 167:1074-1081).

Or as he stated in the same journal"The Lyme disease spirochete . . . can be recovered long after initial infection, even from antibiotic-treated patients, indicating that it resists eradication by host defense mechanisms and antibiotics . . . several eukaryotic cell types provide the Lyme disease spirochete with a protective environment contributing to its long-term survival" (1992; 166(2):440-4).

Or as Raymond Dattwyler (also an IDSA "expert") put it in Reviews of Infectious Diseases, 1989 11(6)S6; S1494-8, "Lyme borreliosis is a chronic infectious disease caused by the spirochete Borrelia burgdorferi."

Or as Drs. Dattwyler and John Halperin (both of IDSA) described in the New England Journal of Medicine in 1998 (319(22): 1441-6), We studied 17 patients who had presented with acute Lyme disease and received prompt treatment with oral antibiotics, but in whom chronic Lyme disease subsequently developed." Or as Dr. Halperin wrote in Neurology in 1992 ((42):43-50), "In many instances continued infection appears to be essential for symptoms to persist, no matter how small the number of organisms, as antimicrobial therapy is generally followed by clinical improvement."

The title of a 1990 American Journal of Medicine (88:21-26) article by the much-quoted Dr. Gary Wormser and Robert Nadelman says it all: "Isolation of Borrelia burgdorferi from the blood of seven patients with Lyme disease" four months after treatment!

Or as Gerold Stanek (also of IDSA) put it in the British Journal of Dermatology in 2001, "The relapses she repeatedly suffered despite initially successful antibiotic treatment could be related to the observation that Borrelia may possibly be able to remain dormant in certain tissue compartments, thus escaping bactericidal antibiotic activity" (144(2):387-392).

Or as Allan Steere, guru of IDSA on Lyme, told the American Journal of Medicine in 1995 (88:4A-44S-51S), “Similarly [as in tertiary syphilis or tuberculoid leprosy], the antigenic stimulus in Lyme arthritis would appear to be a small number of live spiro-chetes, demonstrated here by monoclonal antibodies, which may persist in the synovial lesion for years (p.494)".

Or as Allan Steere, wrote in the New England Journal of Medicine (1990 Nov 22; 323(21):1438-44), "The likely reason for relapse is failure to eradicate the spirochete . . . This last article is one of many studies that show continuing symptoms are most likely due to persistence of the spirochete." ----

 


OUTRAGED AND WILL NO LONGER VISIT THIS SITE
Posted by: magaro
Sep 10, 2007
This article is an outrage !!! It is not accurate ! Is based on false studies and is a designed incomplete review of the literature. Apparently if you get lyme and are treated for 4-8 weeks as described you are told you are cured. Then told you have CFIDS / hypochondria / depression, etc... and then eventually are tested for lyme by PCR and it is positive it does not matter. It is interesting that infectious disease doctors will treat you for a max of 8 weeks, then run a PCR to prove it is gone (cause they know it won't be positive until your off for a month or more). Funny thing was it was positive for someone else I know with lyme!!! Told it could not be right and was probably a lab error. These guidelines are telling doctors that a positive PCR test after their treatment "MUST BE A LAB ERROR" because it is impossible for lyme to exist after the 4-8wks and then the doctors don't treat it. This is malpractice and criminal. And your sites association with this group puts into question all of the information on your site... which is unfortunate.
Reply Reply

The statement you bolded is false and will harm patients. Financial interest?
Posted by: jb200
Sep 11, 2007
The statement you chose to put in bold, that there is no compelling evidence to support long-term antibiotic treatment for chronic Lyme disease, is simply not true. It is indefensible to say this in the face of the "significant" improvement found in two out of three double-blind NIH trials of extended antibiotic therapy. (And the one study that found no improvement has received plenty of criticism, for things like using an antibiotic dose so low that there was no central nervous system penetration.) Several of the authors of this article are also authors of the virtually identical IDSA guidelines, which are so controversial that they sparked an investigation from the Connecticut Attorney General. In fact long-term treatment for Lyme has saved lives and helped thousands, MANY of whom watched their health deteriorate under a false CFIDS diagnosis before Lyme treatment. I am one of those people. I saw well-known CFIDS specialists who were confident in that diagnosis, and failed to consider Lyme. Knowing that so many people diagnosed with CFIDS and FM turn out to have Lyme, and that those who deny the existence of chronic Lyme are especially fond of the CFS & FM labels for these patients, I'm wondering why you would choose to push these "no chronic treatment" Lyme guidelines? Could it be that you have a financial interest in keeping patients labeled with CFS/CFIDS & FM, the ones who buy your supplements? I used to purchase supplements from this site for years. They did me no good whatsoever. Long-term antibiotics, on the other hand, have given me my life back. Go figure.
Reply Reply

Lyme Disease
Posted by: mollystwin
Sep 12, 2007
I echo the previous negative comments about this article. How chould Immune support post such a terrible article!!! I have relied on this site for so much of my information for the past year and a half. To think that such a misleading article could be posted on this website is appalling! I am very disappointed to see this article here.
Reply Reply

Lyme Disease
Posted by: aiden424
Sep 12, 2007
What a terrible article!!! I can't believe that you'd even post it. I have purchased many supplements over the years from immunesupport, but will take my business some where else from now on. I hope everyone else does too!! Kathy
Reply Reply

Trolling?
Posted by: itsy_bitsyone
Sep 13, 2007
I am not going to call you to shame, and it indeed a published review. And you folks didn't write it. However, I have to laugh because what you did was like trolling on your own site! You knew this would inflame Lyme disease sufferers. It was just a bad choice, when you know full well that there is a controversy, an investigation into the ISDA, and plenty of evidence supporting the "other side". The ISDA says there is no proof that there is chronic Lyme. Unfortunately, they cannot prove there's not. This is, then, an opinion. Its integrity is indeed in question. You lose face with sufferers when you post one side of the controversy. If you post one opinion, post another...perhaps something from the studies at Columbia U that states evidence in an NIH funded study that more antibiotics can improve Lyme in people with abnormal spect scans. Or, that reviewed study where they infected the puppies, treated them, euthanized them, and still found bacteria in their brains. Get a healthy debate started, but certainly do not be one-sided. Be fair and balanced or you lose any respect you might now have!
Reply Reply


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