Stereotactic Stimulation of Posterior Hypothalamic Gray Matter in a Patient with Intractable Cluster Headache

Abstract

The study reported by Klempner et al. (July 12 issue) 1 showed that patients with chronic Lyme disease are ill; it also showed that the antibiotics used (intrave-nous ceftriaxone for one month, followed by oral doxycycline for two months) did not lead to improvement. The study did not answer the question of whether better outcomes would have resulted from a longer duration of either intravenous ceftriaxone or oral doxycycline therapy or from treatment with different antibiotics for the same or a longer period. The assumption that ceftriaxone and doxycycline are equivalent and additive treatments for chronic Lyme disease is untested. The mechanisms of action of the two drugs and their intracellular concentrations differ markedly. Klempner et al. cite studies that my colleagues and I have performed with tetracycline 2 but do not discuss the pertinent observations-that tetracycline appears to be more effective than doxycycline, that intracellular-type antibiotics may be more effective than beta-lactams, and that the period of therapy required to achieve stable improvement is much longer than three months. We have since observed that other intracellular-type treatments appear to be effective for the treatment of chronic Lyme disease when they are used for longer periods. 3 There is a need to treat other chronic infections (e.g., tuberculosis, leprosy, Q fever, and hepatitis C) for more than three months. The study by Klempner et al. was a beginning. What we need now, as the next step in finding successful treatments for all patients who are ill with chronic Lyme disease, is additional trials to evaluate alternative antibiotic therapies and different periods of treatment.