Very well written and informative comment. As an interesting aside I’d like to add that the spirochetes themselves may not actually cause damage to the tissues, but rather the immune system responding to their presence causes damage. Wildlife reservoir populations of B. Burgdorferi have actually evolved not to respond to the presence of the bacteria as it doesn’t produce any toxic waste products and in a lab environment they don’t develop any symptoms of tertiary Lyme despite lifelong infection.

> As B. burgdorferi does not produce toxins or extracellular matrix-degrading proteases, most of the manifestations of human Lyme borreliosis at each of the three stages of disease result from inflammation generated by these immune responses.

Additionally, tertiary Lyme may also be due to disregulation of the immune system and not necessarily permanent damage to the tissues. I believe studies have shown modest success with immune modulating drugs. In addition to seeing a neurologist it would also be wise to talk to a rheumatologist. I don’t have a source handy for this claim but do have a paper somewhere that talks about it (I believe they mention it in the Nature paper linked above as well but don’t go into detail). I’ll dig it up and link it some time tomorrow.