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September 1992

Lyme Disease Revisited

Author Affiliations

45A Hancock St Cambridge, MA 02139

Arch Neurol. 1992;49(9):901. doi:10.1001/archneur.1992.00530330019009

To the Editor.  —Bravo for Finkel and Halperin for their excellent review article1 on nervous system involvement by Lyme disease! The article was lucid, temperate, and thoroughly refreshing.I especially enjoyed the authors' commonsense view of the need to adhere to strict scientific principles when diagnosing Lyme involvement in patients with chronic fatigue syndromes or sleep disorders. We must be careful to avoid the expansion of unprovable diagnostic criteria to such disorders, for the potential exists that doing so could create a crisis of accusation, blame, litigation, and professional rhetoric that could further contribute to explosive escalations in health care costs.Since routinely using Western blot techniques to confirm Lyme serologic test results in our practice, we have seen a marked reduction in the number of patients heretofore empirically treated with several thousand dollars worth of home parenteral antibiotics "just to cover all the bases" and render moot the

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