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Cognitive function in post-treatment Lyme disease Do additional antibiotics help?

From the University of Connecticut School of Medicine, Farmington (Dr. Kaplan); Boston University Medical Center, MA (Dr. Klempner, and G.M. Johnson and R.P. Trevino); New York Medical College, Valhalla (Drs. Weinstein and Dornbush, and L. Levy); New England Medical Center, Boston, MA (Drs. Hu and Schmid); and Yale University School of Medicine, New Haven, CT (Dr. Evans).

Address correspondence and reprint requests to Dr. Richard Kaplan, Department of Psychiatry, UConn Health Center, Farmington, CT 06030; e-mail: kaplan{at}psychiatry.uchc.edu

Background : It is controversial whether additional antibiotic treatment will improve cognitive function in patients with post-treatment chronic Lyme disease (PTCLD).

Objective : To determine whether antibiotic therapy improves cognitive function in two randomized double-blind placebo-controlled studies of patients with PTCLD.

Methods : A total of 129 patients with a physician-documented history of Lyme disease from three study sites in the northeast United States were studied. Seventy-eight were seropositive for IgG antibodies against Borrelia burgdorferi, and 51 were seronegative. Patients in each group were randomly assigned to receive IV ceftriaxone 2 g daily for 30 days followed by oral doxycycline 200 mg daily for 60 days or matching IV and oral placebos. Assessments were made at 90 and 180 days after treatment. Symptom severity was measured from the cognitive functioning, pain, and role functioning scales of the Medical Outcomes Study (MOS). Memory, attention, and executive functioning were assessed using objective tests. Mood was assessed using the Beck Depression Inventory and Minnesota Multiphasic Personality Inventory.

Results : There were no significant baseline differences between seropositive and seronegative groups. Both groups reported a high frequency of MOS symptoms, depression, and somatic complaints but had normal baseline neuropsychological test scores. The combined groups showed significant decreases in MOS symptoms, higher objective test scores, and improved mood between baseline and 90 days. However, there were no significant differences between those receiving antibiotics and placebo.

Conclusion : Patients with post-treatment chronic Lyme disease who have symptoms but show no evidence of persisting Borrelia infection do not show objective evidence of cognitive impairment. Additional antibiotic therapy was not more beneficial than administering placebo.

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