—We appreciate Cameron's comments and the opportunity to discuss the management of patients with Lyme disease who have been previously treated with oral antibiotics. Although objective cognitive deficits were present in 60% of our sample,1 we do not suspect that for most of the patients this was due to continued brain infection. Only one patient had intrathecal antibody synthesis. No patient showed pleocytosis or protein level elevation in the cerebrospinal fluid. Therefore, we suspect that indirect consequences of infection may be a better explanation for the continued symptoms. In contrast to our group of patients where continued spirochetal infection was unlikely, Logigian and colleagues2 noted that 75% (18/24) of their patients with encephalopathy had abnormal findings in the cerebrospinal fluid, including intrathecal Borrelia burgdorferi—antibody synthesis, pleocytosis, or protein level elevation, findings which suggest that continued brain infection was present.The subsequent management of the patients
Krupp LB, Coyle PK, Halperin JJ. Cognitive Function in Late Lyme Borreliosis-Reply. Arch Neurol. 1992;49(10):1011. doi:10.1001/archneur.1992.00530340027011
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