Is Lyme Disease Curable? The Complications

• If not treated correctly and early on, Lyme symptoms can persist. Different variations of late-stage Lyme Disease include (Radolf JD, 2021):
• Late Neuroborreliosis
• Post Treatment Lyme Disease Syndrome
• Chronic Lyme Disease

Late Neuroborreliosis

In late neuroborreliosis, Lyme symptoms become neurological. Inflammation of the spinal nerve roots, pain, facial palsy, CNS infection affecting the spinal cord or the brain, encephalitis or stroke are all possible symptoms (Rauer S, 2018).

Conventional medicine typically uses antibiotics to treat patients with neurological signs of Lyme neuroborreliosis (Rauer S, 2018). The current recommendation is 2-3 weeks of antibiotics. There is not a lot of research on treatment. But the information does show that taking antibiotics for longer, by a further 100 days, showed no clinical advantage over a placebo (Rauer S, 2018). Which antibiotic or how it is given (oral vs IV) does not seem to matter either (Rauer S, 2018). An antibiotic should be chosen according to patient-specific aspects such as allergies, age, pregnancy and how it is administered (Rauer S, 2018).

In most trial studies, a 1–2-week course of antibiotics improved neurological symptoms in most patients within a few weeks to months (Rauer S, 2018). Lyme neuroborreliosis patients typically stabilized within one year after treatment.

But 60–80% of those with late neuroborreliosis can still experience lingering neurological symptoms (Rauer S, 2018).

That is a high proportion of patients who do not completely recover with conventional treatments. This is where Functional Medicine can help with a more targeted diagnosis and treatment plan.

Post Treatment Lyme Disease Syndrome(PTLDS)

In post-treatment Lyme Disease syndrome or PTLDS, patients have symptoms that persist after treatment. Symptoms include fatigue, pain and cognitive difficulties. These persist past the initial antibiotic treatment of acute LD, and last over six months or longer post-treatment (Maksimyan S, 2021).

PTLDS occurs in approximately 10% of patients with Lyme Disease, following antibiotic treatment (Fitzgerald BL, 2021). Relatively little is known about it. Researchers have not been able to identify why some people get PTLDS or what the predisposing factors are. It is also quite tough to diagnose, treat and prevent (Maksimyan S, 2021).

Long-term trials of antibiotics are the most researched treatment plans for PTLDS. However, the specific antibiotics used, the length of treatment, the symptoms being treated and the outcomes vary amongst these studies. This makes it difficult to make comparisons and conclusions about treatment (Maksimyan S, 2021). But these studies do indicate that longer-term antibiotics for these persistent symptoms of LD have no additional benefits over a 2-week course of antibiotics (Maksimyan S, 2021).

Chronic infection with Borrelia burgdorferi should not be assumed in patients with PTLDS symptoms. They should not necessarily be treated with more antibiotics, as research shows that more antibiotics do not help. Instead, it is better to do a thorough medical evaluation and treat the specific symptoms (Rauer S, 2018).

One study from the late 1990s looked at whether post-LD symptoms, especially severe fatigue and slower mental speed, would improve with long-term antibiotics (Maksimyan S, 2021). The study found that antibiotics only improved some symptoms and may not be the right approach for every patient (Maksimyan S, 2021).

There may be adverse effects from longer antibiotic use (Maksimyan S, 2021). In one study, 73% of patients on antibiotics reported an adverse event. The most common events were rash, diarrhea and allergic reactions. 6.8% of patients had to drop out of the study due to side effects (Maksimyan S, 2021). In more serious cases, there are worse side effects from prolonged antibiotic use including possible death (Maksimyan S, 2021).

Once again, it is critical to get a correct diagnosis to avoid over-prescribing antibiotics (Maksimyan S, 2021).

How common is PTLDS?

It is difficult to predict the likelihood of developing PTLDS but one study does give us an estimate (Maksimyan S, 2021). This relatively small study showed 35% of participants had PTLDS, and that these patients had significantly lower function and quality of life within six months of treatment. This study specifically recruited patients with early-diagnosed LD who received immediate treatment.

Various medications have been trialed to treat PTLDS but so far none have been found to be effective (Maksimyan S, 2021).

One encouraging study looked at a non-pharmaceutical therapy for chronic Lyme disease: resistance training in patients. People with a previous LD diagnosis and symptoms persisting for at least three months after treatment were recruited. After a supervised 4-week resistance exercise training, they had significant improvement in their joint pain symptoms, exercise performance and the number of days they felt healthy and full of energy (Maksimyan S, 2021).

Chronic Lyme Disease (CLD)

Chronic Lyme Disease can significantly affect a person’s quality-of-life. CLD is when patients have unexplained on-going symptoms. CLD can include a range of symptoms such as fatigue and chronic pain which occur due to a lengthy Borrelia infection.

Often, people don’t notice a tick bite or may not get a bulls-eye rash. They may not think of getting checked for Lyme and may have a long delay in getting a correct diagnosis. This can lead to chronic Lyme. Or their antibiotics treatment may not work, as it is not a fail-proof cure. Patients with chronic, long-standing Lyme Disease are often sick for long periods of time following treatment or may experience a worsening of their Lyme symptoms despite treatment (Shor S, 2019).

What are the Mechanisms of CLD?

Possible causes of Chronic LD include (Shor S, 2019) and (Hout, 2018):

• Tissue injury from the pathogenic bacteria, Borrelia burgdorferi. It can invade a wide range of cells such as fibroblasts, glial and neuronal cells, endothelial cells, lymphocytes, synovium, skin, ligaments, cardiac tissue, lymph nodes and tonsillar lymphoid tissue (Shor S, 2019).
• Lyme-induced secondary conditions
• Unrecognized or undertreated co-infections
• Immune dysfunction: post-treatment immune dysfunction could be due to a failure to clear antigenic debris, the formation of autoantibodies or a persistent elevation of immune mediators.
• A persistent Borrelia infection may evade the immune system by forming and hiding behind biofilms.
• Unregulated inflammation

As we know, most likely more than one mechanism will be involved for a given patient and each person needs to be looked at as an individual and unique case.

CLD Treatment

Studies show that additional or longer courses of antibiotics do not help patients after being treated the first time for Lyme (Halperin, 2015). Antibiotics are ineffective in patients with persistent fatigue and cognitive symptoms following appropriately diagnosed and treated Lyme disease (Halperin, 2015). This can even put patients at risk of side effects from the antibiotics (Halperin, 2015).

We would recommend that patients who have tried antibiotics and are still not cured look to Functional Medicine to find the underlying causes for symptoms and treat them with a more targeted approach than just antibiotics.

Co-Infections of Lyme Disease

We will look at Lyme Disease co-infections in another blog. It is an important topic and can affect the outcome and success of treatment. However, it is beyond the scope of this article so please stay tuned for a future blog on Lyme co-infections

Degenerative Neurological Diseases

Lastly, a great concern is when LD goes misdiagnosed or untreated. In these cases, LD can, years later, be diagnosed as chronic inflammatory age-related degeneration (for example arthritis, dementia or stroke). This is partially due to the increased complications of aging for those with persistent and untreated Lyme Disease.  

Some neurological diseases can even be partially caused by Lyme Disease. We have written extensively about this and you can find the links to blogs here, including Lyme and Alzheimer’s, Lyme and Parkinson’s, Lyme and ALS and Lyme and MS.

Lyme Disease is usually curable. It is best to catch it as early as possible. It is critical to seek medical advice as soon as you realize that you have been bitten by a tick, have a bull’s eye rash or suspect you may have been exposed to Lyme Disease after time in nature.

As always, please get in touch with us. If you or someone you know is struggling with pain, fatigue or other issues related to Lyme Disease, contact our clinic today. We can work on any issue(s) and improve your health. Book a free health evaluation call with us today, to see how we can help you with your concerns. We can answer your questions and help you book an initial consult with one of the functional medicine doctors in our clinic.

** Please stay tuned for our next Blog!  **