Diagnosis and management of Lyme neuroborreliosis.

Halperin JJ. Expert Rev Anti Infect Ther. 2018.


The nervous system is involved in 10-15% of patients infected with B. burgdorferi, B. afzelii and B. garinii. This review will address widespread misconceptions about the clinical phenomenology, diagnostic approach and response to treatment of neuroborreliosis. Areas covered: Improvements in diagnostic testing have allowed better definition of the clinical spectrum of neuroborreliosis, with lymphocytic meningitis and uni- or multifocal inflammation of peripheral/cranial nerves predominating. Despite widespread concern that post-treatment cognitive/behavioral symptoms might be attributable to persisting infection or aberrant inflammation within the central nervous system a large body of evidence indicates this is extremely improbable. Importantly, recent studies show most neuroborreliosis can be treated with fairly brief courses of oral antibiotics. All high-level evidence confirms that prolonged courses of antibiotics carry harm with no commensurate benefit. Expert commentary: Lyme disease in the US, and corresponding disorders in Europe, are well defined neuro-infectious diseases that are highly responsive to antibiotic therapy. Although the nervous system is slow to recover after insults (e.g. persistent facial weakness after appropriately treated facial nerve palsy) 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.



While I would love to read this in its entirety for amusement, I refuse to pay $1 let alone $90 for 24 hour access.

Just from the abstract it is evident that it is another great example of why a medical condition never makes forward progress.  “Experts” like Halperin refuse to rethink the paradigm.

  • This article focuses only on borrelia, a formidable foe alone, an absolute shape-shifting beast on steroids when coupled with Babesia, Bartonella, Anaplasma, and other critters.  The one disease, one drug paradigm needs to go straight into the garbage can, and until this happens we are doomed.
  • The 10-15% patient statistic with nervous system involvement also needs to go straight into the can.  Nobody has a clue on numbers on any of this.  If the CDC goes from 30,000 new cases to over 300,000 new cases a year, I think we need to wave the white flag and admit our ignorance.
  • Without reading the entire faulty article, I have a deep rooted suspicion that this “review” is based on other deeply flawed articles and studies from the past made by the Cabal. and
  • Diagnostic testing has not improved with the CDC even stating numerous tests might be needed:
  • A recent study states that treating prophylactically if TBI’s are suspected is warranted:  Also see:, and
  • The definition of the clinical spectrum of neuroborreliosis is not better.  While it is true that more is being reported on, there is absolutely no consensus on any sort of definition.
  • The persisting infection/aberrant inflammation issue is not over just because Halperin reviews old Cabal manuscripts and claims there is a “wide body of evidence.”  As they say, Garbage in, garbage out.
  • Brief courses of antibiotics do work for some people, typically acute cases; however, there is much to indicate that many relapse and continue to have symptoms.  To say otherwise indicates bias of the highest sort.
  • His usage of “high-level evidence” also indicates an extreme personal bias indicating that the rest of us poor fools have low-level evidence.  Please, I know a slam when I hear one.  Nobody in Lyme-land is arguing that antibiotics do not have risks.  Many if not most treatments have risks, including drinking water; however, as with any disease state, the doctor and patient must discuss and weigh the risk/benefit ratio for sure.  An IDSA Founder, Dr. Waisbren, successfully used high powered IV antibiotics and wrote a book on 51 tough cases.  All improved.  Again, there are so few studies looking at long-term antibiotic benefit on Lyme/MSIDS that this statement is premature and misleading.  I work with people on a daily basis who state they wouldn’t be alive today without the very treatment he is slamming, and trust me, we would all love an effective treatment with fewer risks!  
  • The “expert commentary” is only expert in my opinion if it takes into account numerous physicians who have actually treated complicated Lyme/MSIDS cases over decades of time, who are open-minded, are willing to change, and are continually studying, listening and learning from others.  Halperin fails on many accounts.  Keep reading below to see why.
  • This review is nothing more than a regurgitation of ancient, unscientific, and biased opinion.

In this interview  Halperin repeats the common myth that Lyme takes 24-49 hours or more to be transmitted, that it is primarily an Eastern problem (go to page 6 and read about Speilman’s maps which were faulty but have ruled like the Iron Curtain), and that you typically have flu-like symptoms (My initial symptoms were gynecological).  He treats everyone with 2-4 weeks of antibiotics.

A quick search reveals Halperin commonly serves as an “expert” witness in medical malpractice cases defending physicians accused of failing to diagnose Lyme.  

Here’s a lengthy article Article Kicking and LLMDs Personal View coauthored by Halperin which states,

“Advocacy for LD has become an increasingly important part of an anti science movement that denies both the viral cause of AIDS and the benefits of vaccines and that supports unproven (sometimes dangerous) alternative medical treatments.”  

Oh, and somehow patients, advocates, and their doctors pose a threat to public health.

 Here’s a few telling Halperin quotes:
QUOTE-  “When physicians who diagnose chronic Lyme disease obtain laboratory tests to provide support for their diagnoses, they often rely heavily on “Lyme specialty laboratories.” Such laboratories may perform unvalidated in-house tests that are not regulated by the Food and Drug Administration, or they may perform standard serologic tests interpreted with the use of criteria that are not evidence-based.1” Source
QUOTE-  “Antibiotic therapy can cause considerable harm to patients treated for chronic Lyme disease or post–Lyme disease symptoms.” Source
QUOTE-  “Although anecdotal evidence and findings from uncontrolled studies have been used to provide support for long-term treatment of chronic Lyme disease,18-20 a response to treatment alone is neither a reliable indicator that the diagnosis is accurate nor proof of an antimicrobial effect of treatment.” Source
QUOTE-  “It is highly unlikely that post–Lyme disease syndrome is a consequence of occult infection of the central nervous system.” Source
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