Did you know that Lyme disease can sometimes cause facial paralysis?
Facial Palsy 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.
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 a bacterial infection transmitted by the bite of an infected tick.
Facial weakness due to Lyme disease tends to occur 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.
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 possibility of Lyme disease. In some cases of Lyme disease, facial palsy may be the first symptom for which they seek medical attention' (they may have had preceding symptoms attributed to something else)
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. A UK study published in 2020 concluded that “In areas endemic with Lyme disease, Lyme disease should be considered as the likely cause of facial nerve palsy in children until proven otherwise.” [5]
The Lyme Resource Centre website provides information on ticks, tick bite prevention and Lyme disease.
To learn more about other causes of Facial Palsy visit Facial Palsy UK
Comments