Lyme disease & Facial Palsy

Did you know that Lyme disease can cause facial paralysis? 

Credit: CDC

Facial Nerve Palsy (FNP) is the term used to describe weakness or paralysis of the facial muscles,  due to damage to the facial nerve. There are many different causes and the damage may be temporary or permanent.

List of causes - Facial Palsy UK

Bell’s Palsy

The most common cause of facial paralysis is Bell’s palsy, which often comes on suddenly over hours or days and causes complete or partial paralysis of, usually, one side of the face. The cause of Bell’s palsy is not absolutely clear, though it is thought to be related to viral infections. 

Bell’s palsy is usually treated with corticosteroids and sometimes anti-viral medication. 

Lyme disease-related Facial Palsy

Lyme disease is caused by the bacteria Borrelia burdorferi and transmitted by the bite of an infected tick.

Facial nerve palsy due to Lyme disease tends to occur in early disease, usually within 7-21 days of becoming infected, though can also occur much later.  It may affect one or both sides of the face.  According to research, approximately 5-10% of patients diagnosed with Lyme disease may develop facial palsy [1]

At this early stage, there may or may not be other symptoms of Lyme disease. The most common symptom is an  erythema migrans rash, though this only occurs in around two thirds of cases. Other symptoms may include fever, chills, headache, fatigue, neck stiffness, joint or muscle aches and other neurological symptoms such as pain or weakness.

Blood tests are known to be unreliable in early Lyme disease and diagnosis may rely on known exposure to ticks and the presence of associated symptoms.

Lyme disease requires treatment with antibiotics  Lyme disease | Guidance | NICE 

When to consider Lyme disease rather than Bell's palsy:

Whilst both conditions may produce very similar symptoms, they require completely different treatments. Factors which might indicate Lyme disease include:

• A tick bite or possible tick exposure in the previous weeks or months.

• An erythema migrans rash or other undiagnosed rash(es). 

• Flu-like symptoms, headaches, fever or chills, neck stiffness, fatigue, joint or muscle aches, other neurological, or cardiac symptoms. 

• Bilateral facial weakness.( can be unilateral or bilateral).

• Facial palsy occurring in summer or early autumn (though does occur throughout the year) [2].

  
  

Note that in early Lyme disease, blood tests are unlikely to be reliable, meaning that a negative test result can not be used to exclude the diagnosis. In some cases of Lyme disease, facial palsy may be the first symptom for which a person seeks medical attention (they may have had preceding symptoms attributed to another cause)

The importance of early diagnosis:

Although Bell’s palsy is the most common cause of facial palsy, it is important for healthcare professionals to consider the possibility of Lyme disease for the following reasons:

• Early, adequate antibiotic treatment of Lyme disease provides the best chance of recovery.

• If left undiagnosed and untreated, Lyme disease could persist and spread around the body, causing more severe symptoms, which may be difficult to treat [3].

• The standard treatment for Bell’s palsy is corticosteroids, which can have detrimental long-term outcomes if used in patients with Lyme disease facial palsy [4].

  
  

Facial Nerve Palsy in children:

Facial nerve palsy is uncommon in children, but is the most common presenting symptom of neurological Lyme disease in children. [5]

A UK study published in 2020 concluded:

“In areas endemic with Lyme disease, Lyme disease should be considered as the likely cause of facial nerve palsy in children until proven otherwise.” [6]

It is important to remember that facial nerve palsy  usually occurs in early Lyme disease, when testing is known to be inaccurate. Therefore a negative Lyme disease test does not exclude the diagnosis of Lyme disease.  Lyme disease | Guidance | NICE 

Patients and carers may need to highlight the possibility of tick exposure or other symptoms consistent with Lyme disease.

1.  Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States - PubMed 

2.  Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England - PubMed 

3. Lyme Disease Treatment | Prognosis for Lyme Patients after Treatment 

4. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes - PubMed

5. View of Approach of pediatric neuroborreliosis | Belgian Journal of Paediatrics 

6. High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region - ScienceDirect 

The Lyme Resource Centre website provides information on ticks, tick bite prevention and Lyme disease. 

https://www.lymeresourcecentre.com/info  

To learn more about other causes of Facial Palsy visit Facial Palsy UK