User talk:Borreliacell

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– the WikiProject Medicine team Doc James  (talk · contribs · email) 01:09, 15 April 2019 (UTC)

What text of the ref supports?
" However, retreatment may actually not be offered, because the guidelines do not define how to assess failure of the initial treatment. "

Best Doc James  (talk · contribs · email) 21:43, 15 April 2019 (UTC)

The document uses the expression "treatment failure" in Table 2 but never defines it anywhere (even in later papers, author JJ Halperin uses "treatment failure" in the same loose sense,    without ever defining it.) On the other hand, the document clearly defines "post-Lyme syndrome" as "occurs in patients    who have had Lyme disease, but, after treatment that would normally be expected to be effective,    have continued to have residual chronic symptoms," and goes into a lengthy argument condemning antibiotic treatment for it and concluding "published antibiotic treatment trials of PLS provide   compelling Class I evidence that PLS is not due to active Borrelia infection and is not     responsive to further antibiotic therapy." So, when a North American patient with neuroborreliosis returns to the doctor with neurologic complaints after a full course of doxycycline, is that a case of treatment failure or    post-lyme syndrome? The guidelines offer no guidance on this question. When I first read the guidelines, I found it obvious that in such a case a second, parenteral course of antibiotics would be given to the patient in an attempt to get him or her well. However, to my surprise, almost every doctor I know interprets the guidelines the other way and withholds further antibiotic treatment. I think this sentence should be reinstated in the article because it might be read by people trying to decide between treatment options for neuroborreliosis: They should know that, no matter what they think the guidelines mean, the first course of antibiotics is very likely to be the only one (from a mainstream doctor).

Also what text of the ref supports "Healing of facial palsy is not a sure sign of antibiotic treatment success. "? Doc James  (talk · contribs · email) 21:44, 15 April 2019 (UTC)


 * The text I see is "Although antibiotic treatment may not hasten the resolution of seventh cranial nerve palsy associated with B. burgdorferi infection, antibiotics should be given to prevent further sequelae (A-II)."
 * Which does not support. Doc James  (talk · contribs · email) 21:46, 15 April 2019 (UTC)

In "Background and Diagnosis of Early Neurologic Lyme Disease," just before "Recommendations:" "all patients with cranial nerve palsy in association with Lyme disease should receive antibiotic   therapy, not primarily for the purpose of expediting recovery from the paralysis, which will     usually resolve within a few weeks regardless of whether antimicrobial therapy is given, but    rather to prevent later complications" The purpose of antibiotic treatment is to prevent later complications, not to resolve facial palsy. It should be considered successful when it prevents those later complications, not when the palsy resolves, which would be nearly as likely to happen regardless of treatment.

Borreliacell (talk) 03:00, 16 April 2019 (UTC) Borreliacell (talk) 03:11, 16 April 2019 (UTC)


 * This is original research "However, the guidelines do not define how to distinguish between treatment failure and post-treatment Lyme disease syndrome"
 * It is your interpretation of the guideline and is not permitted. Best Doc James  (talk · contribs · email) 19:50, 16 April 2019 (UTC)

OK. Borreliacell (talk) 12:28, 17 April 2019 (UTC)

Diagnosis
Goes in the diagnosis section. Not the symptom section. Doc James (talk · contribs · email) 03:32, 20 April 2019 (UTC)