Nev Zubcevik, DO
Chief Medical Officer
This course is intended to help clinicians decide when to order radiologic tests for CNS Lyme disease, based on symptoms and clinical presentation. This concise, data-driven overview will help clinicians quickly decide which radiologic tests to order after a tick-bite, potentially speeding up treatment decisions and saving lives. This is part 2 in a three course series on this topic.
- Describe clinical presentations of CNS Lyme Disease
- Describe ways to initialize differential diagnosis and diagnostic tools
- State three peer-reviewed references supporting treatment of CNS Lyme Disease
This session, Part 2 | Diagnostic, treatment & rehabilitation strategies for patients with CNS Lyme disease, is approved for 0.5 enduring AAFP Prescribed credits.
AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.
The AAFP has reviewed One Health Medical Education for a Changing Climate, and deemed it acceptable for AAFP credit. Term of approval is from 01/02/2023 to 01/01/2024. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Evidence-based bibliography for further study
Belman AL, Iyer M, Coyle PK, Dattwyler R. Neurologic manifestations in children with North American Lyme disease. Neurology. 1993 Dec;43(12):2609-14. doi: 10.1212/wnl.43.12.2609. PMID: 8255465.
Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, et al. (2012) Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection. PLOS ONE 7(1): e29914. https://doi.org/10.1371/journal.pone.0029914
Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, Luft BJ. Ineffectiveness of tigecycline against persistent Borrelia burgdorferi. Antimicrob Agents Chemother. 2010 Feb;54(2):643-51. doi: 10.1128/AAC.00788-09. Epub 2009 Dec 7. PMID: 19995919; PMCID: PMC2812145.
Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice Hodzic E, Imai D, Feng S, Barthold SW (2014) Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice. PLOS ONE 9(1): e86907. https://doi.org/10.1371/journal.pone.0086907
Adriana Marques, Sam R. Telford, III, Siu-Ping Turk, Erin Chung, Carla Williams, Kenneth Dardick, Peter J. Krause, Christina Brandeburg, Christopher D. Crowder, Heather E. Carolan, Mark W. Eshoo, Pamela A. Shaw, Linden T. Hu, Xenodiagnosis to Detect Borrelia burgdorferi Infection: A First-in-Human Study, Clinical Infectious Diseases, Volume 58, Issue 7, 1 April 2014, Pages 937–945, https://doi.org/10.1093/cid/cit939
Jowett N, Gaudin RA, Banks CA, Hadlock TA. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope. 2017 Jun;127(6):1451-1458. doi: 10.1002/lary.26273. Epub 2016 Sep 6. PMID: 27598389
Hildenbrand P, Craven DE, Jones R, Nemeskal P. Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. AJNR Am J Neuroradiol. 2009 Jun;30(6):1079-87. doi: 10.3174/ajnr.A1579. Epub 2009 Apr 3. PMID: 19346313; PMCID: PMC7051319.
Lindland ES, Solheim AM, Andreassen S, Quist-Paulsen E, Eikeland R, Ljøstad U, Mygland Å, Elsais A, Nygaard GO, Lorentzen ÅR, Harbo HF, Beyer MK. Imaging in Lyme neuroborreliosis. Insights Imaging. 2018 Oct;9(5):833-844. doi: 10.1007/s13244-018-0646-x. Epub 2018 Sep 4. PMID: 30187265; PMCID: PMC6206375.
Garkowski A, Zajkowska J, Zajkowska A, Kułakowska A, Zajkowska O, Kubas B, Jurgilewicz D, Hładuński M, Łebkowska U. Cerebrovascular Manifestations of Lyme Neuroborreliosis-A Systematic Review of Published Cases. Front Neurol. 2017 Apr 20;8:146. doi: 10.3389/fneur.2017.00146. PMID: 28473801; PMCID: PMC5397664.
Wittwer B, Pelletier S, Ducrocq X, Maillard L, Mione G, Richard S. Cerebrovascular Events in Lyme Neuroborreliosis. J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1671-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.056. Epub 2015 May 20. PMID: 26002071.
Eric L. Logigian, Richard F. Kaplan, Allen C. Steere, Successful Treatment of Lyme Encephalopathy with Intravenous Ceftriaxone, The Journal of Infectious Diseases, Volume 180, Issue 2, August 1999, Pages 377–383, https://doi.org/10.1086/314860