Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

Abstract

Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.

Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States

“…As shown in our and other studies, 6,7,11,12,16,19,[27][28][29][30] the history and clinical picture will often give clues pointing toward the diagnosis of LNB. Most cases occur in the summer months.…”

“…Most studies supporting the use of intrathecal AI index are from Europe, where the sensitivity of tests range from 42% to 91%. 7,11,12,29,30,32,36 The impression based on the few early US studies is that a positive intrathecal AI is less common in the US. 14,17,25,37 Our results, while evaluated in only 15 patients, shows an overall sensitivity of 40% when using a cutoff >1.5, increased to 87% when using a cutoff value ≥1.0.…”

Neurologic Complications of Lyme Disease

“…Spinal fluid analysis may be considered in patients with facial nerve palsy and negative Lyme disease serology in a Lyme disease–endemic area when they have headache and present during tick season, even if they have no history of a recent tick bite or the appearance of a lesion of erythema migrans 1 . Alternative approaches to obtaining CSF analysis would be to treat with corticosteroids and repeat serology several weeks later or treat with corticosteroids and doxycycline (see the section titled “Treatment”) while awaiting repeat Lyme disease serology.…”

“…In a series of 559 patients presenting with a facial nerve palsy in a Lyme disease-endemic area, Lyme disease was the etiology in 4.7% of patients. 1 The majority of patients with facial nerve palsy due to Lyme disease presented in the months of July to September, and most had headache. 1 Less commonly, cranial nerves III, IV, VI, and VIII may be involved.…”

“…In North America, only one spirochete in the genus Borrelia causes Lyme disease, Borrelia burgdorferi. 1 In addition to B. burgdorferi, other Borrelia species causing Lyme Disease in Europe include Borrelia afzelii and Borrelia garinii (and the much rarer Borrelia spielmanii and Borrelia bavariensis).…”