There are several possible reasons why neurological condition deteriorates at the end of a 52-day course of antibiotics, especially during the last 5–7 days, and this does not necessarily mean that “the infection has spread”. After prolonged antibiotic treatment, the body’s biological reserves may be depleted: changes in the intestinal flora, malabsorption, vitamin and trace element deficiencies, and increased stress on the liver can in themselves cause neurological symptoms (increasing headaches, concentration problems, dizziness, paresthesia, cognitive slowing). If adequate preparation and support – protection of the intestinal flora, targeted supplementation, strengthening of the body’s regenerative capacity – did not take place before and during therapy, then by the end of the long course of treatment the body may be “overloaded”, which can also manifest itself in the form of neurological deterioration.
Another important consideration is the choice of antibiotic. Due to the genetic variability and intracellular behaviour of Borrelia burgdorferi sensu lato, not all preparations have the same effect on all clinical forms, especially in cases of neurological involvement. If the chosen agent is not optimal, or if it is used in monotherapy in a complex, protracted process, it is possible that at the end of treatment, instead of improvement, stagnation or even deterioration may be observed. In such cases, it is not necessarily the length of the treatment that is decisive, but rather the extent to which the therapy was personalised, taking into account the patient’s antibiotic history, clinical symptoms and current physical condition.
The Jarisch-Herxheimer reaction is unlikely to be the explanation in this situation, as it typically occurs within hours of starting antibiotics and is short-lived. Increasing neurological deterioration at the end of a treatment lasting more than 7 weeks is more likely to indicate exhaustion of the body, inadequate support or the need to review the therapy. A possible cause could also be an untreated co-infection. In such cases, it is advisable to reconsider the treatment: laboratory monitoring, strengthening of the body’s support, and, if necessary, modification of the antibiotic strategy, rather than automatically extending the course of treatment.
The preparation and treatment plan developed by the Lyme Borreliosis Foundation’s team of physicians can help your doctor develop further options.
(C) Lyme Borreliosis Foundation
