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Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1998 (Published 30 May 2018) Cite this as: BMJ 2018;361:k1998

Re: Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

I appreciate the lengths Obel and colleagues took to describe the long-term outcome for European Lyme neuroborreliosis patients using a nationwide population based cohort. Unfortunately, the Denmark cohort study was not designed to assess important long-term complications of Lyme disease.1 The authors did not have access to individual records or patients to assess these long-term complications of Lyme disease. Instead, the authors had to rely on Danish Civil Registration System.

The authors reported a reduction in employment rate and income for patients with Lyme Neuroborreliosis compared to controls. Their measures of social functioning and education (divorce rates, math scores and incidence high school completion) left many unresolved questions. The Denmark cohort study was not designed to assess the incidence of other complications of Lyme disease including chronic neurologic Lyme disease,2 Lyme encephalopathy,3,4 post Lyme disease,5 neuropsychiatric Lyme,6 and Post treatment Lyme disease.7 The problems for Lyme disease patients might have been clearer if the authors had access to the medical record and patients.

1. Obel N, Dessau RB, Krogfelt KA, et al. Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study. BMJ. 2018;361:k1998.
2. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med. 1990;323(21):1438-1444.
3. Kaplan RF, Jones-Woodward L, Workman K, Steere AC, Logigian EL, Meadows ME. Neuropsychological deficits in Lyme disease patients with and without other evidence of central nervous system pathology. Appl Neuropsychol. 1999;6(1):3-11.
4. Fallon BA, Keilp JG, Corbera KM, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.
5. Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60(12):1923-1930.
6. Fallon BA, Schwartzberg M, Bransfield R, et al. Late-stage neuropsychiatric Lyme borreliosis. Differential diagnosis and treatment. Psychosomatics. 1995;36(3):295-300.
7. Rebman AW, Bechtold KT, Yang T, et al. The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Posttreatment Lyme Disease Syndrome. Front Med (Lausanne). 2017;4:224.

Competing interests: No competing interests

07 June 2018
Daniel J Cameron
Physician
First Medical Associates
657 East Main St