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Bell’s Palsy Lyme Disease Treatment

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#66 Bell’s Palsy and Lymes Disease – How to prevent it

Dr. Babak Azizzadeh of The Facial Paralysis Institute is a globally recognized facial plastic and reconstructive surgeon who helps patients dealing with long-term facial paralysis related to Lyme disease. He is happy to explore treatment options to help a Lyme disease patient achieve long-lasting relief from their facial paralysis symptoms. To schedule a consultation with Dr. Azizzadeh,please contact us online or call us today at 657-2203.

What Is Neurologic Lyme Disease

Neurologic symptoms of Lyme disease occur when the Lyme disease bacteria affect the peripheral or central nervous systems.

  • Cranial nerve involvement: When the cranial nerves are affected, facial palsy can occur on one or both sides of the face.
  • Peripheral nerve involvement: When the peripheral nerves are affected, patients can develop radiculoneuropathy which can cause numbness, tingling, shooting pain, or weakness in the arms or legs.
  • Central nervous system involvement: When the central nervous system is affected, Lyme meningitis can cause fever, headache, sensitivity to light, and stiff neck.

Out of every 100 patients whose cases are reported to CDC, 9 have facial palsy, 4 have radiculopathy, and 3 have meningitis or encephalitis. Because of reporting practices, this statistic may overestimate how often these manifestations are seen by clinicians.

Bells Palsy Due To Lyme Disease Misdiagnosed Patient Bedridden

In their study Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis, Kayal and colleagues describe the case of a 23-year-old woman, living in India, who was misdiagnosed with bilateral facial nerve palsy.

Until recently, India has been considered a non-endemic region for Lyme disease, the authors point out. And, Although it had been considered extremely rare in India, a recent study conducted in Nagarahole and Bandipur in South India surprisingly revealed a high seroprevalence of Borrelia burgdorferi infection in a population at risk .

According to the case report, the young woman was admitted to the hospital with rapidly evolving progressive weakness of all four limbs, and lancinating pain over the back of the neck and lower back, radiating to upper and lower limbs.¹

Her symptoms had developed over a 1-week period and left the patient bedridden. Ten days prior, she had developed a fever, which resolved within 2 days.

Two months before the onset of symptoms , she developed a slight deviation of her angle of the mouth toward the left side, along with grossly decreased taste sensation and difficulties in closing eyes, blowing, and whistling. This lasted for one month.

She was diagnosed with right-sided Bells palsy but Lyme disease was not considered, initially.

The woman was treated with methylcobalamine and prednisolone. However, her symptoms did not improve.

The authors suggest:

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Lyme Disease And Bells Palsy Diagnosis

Laboratory tests are commonly used to diagnose Lyme disease. These tests require a blood sample from a patient.

Initially, a blood test is taken to determine if a patient is dealing with Lyme disease. If a patient tests negative for Lyme disease, no further testing is required. However, if a patient tests positive or the initial test results are unclear, a second test is used to verify Lyme disease is present.

Lab tests are also used to diagnose Bells palsy or other forms of facial paralysis. A neurologic and ear, nose, and throat evaluation are also performed. Other tests that may be completed include a test of a patients ability to produce tears, computed tomography scan, magnetic resonance imaging exam, and electromyography or electroneurography .

Comprehensive testing is key to accurately diagnose Lyme disease and Bells palsy. These conditions can occur in combination with one another or separately, and testing ensures a patient can find out if one or both are present. Following testing, a patient can pursue treatment options that deliver long-lasting symptomatic relief.

Facial Palsy: An Important Clue Pointing To Neurological Lyme Disease

Is Bell

byCara DeAngelis, Ph.D.on March 28, 2022

Global Lyme Alliance scientific advisory board member, Dr. Adriana Marques, led a study on Lyme neuroborreliosis patients, who take corticosteroids in addition to antibiotics, and whether or not the treatment had a negative effect on facial palsy recovery.

Lyme disease is conventionally divided into three clinical stages: early, early disseminated, and late disseminated. The disseminated stages occur when the Lyme disease bacterium, Borrelia burgdorferi, travels from the initial tick bite site in the skin to the rest of the body, such as the heart, joints, and nervous system. Once B. burgdorferi has spread to the nervous system, it is called Lyme neuroborreliosis. The most common symptoms in Lyme neuroborreliosis include:

  • Radiculoneuritis .

Lyme neuroborreliosis occurs in about 15% of untreated Lyme patients in the US, and there are few studies describing treatment and recovery for facial palsy. Corticosteroids have been shown to improve facial palsy when a bacterial infection is not suspected, but the impact of dual therapy with antibiotics and corticosteroids on facial palsy is not well established.

Hodgens A, Sharman T. Corticosteroids. . In: StatPearls . Treasure Island : StatPearls Publishing 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/

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First of all I need to say that I have never had such a positive experience with anyone in the medical profession in any situation as I have had with Dr. Robert Oliver. I believe his quick diagnosis has saved my life My initial call to the office was handled with great concern by the staff. Dr. Olivers concern for me continued well after my surgery. I was never made to feel rushed or unimportant and I am honored to be one of Dr. Olivers patients. I highly recommend his services.

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How Does Bells Palsy Affect Pregnancy

For unknown reasons, pregnant women are three times more likely to develop Bells palsy than women who arent expecting. The condition typically occurs during the third trimester. You may be more likely to develop Bells palsy while pregnant if you have preeclampsia or gestational diabetes.

If your symptoms are severe, your healthcare provider may recommend treatment. Certain treatments, such as oral corticosteroids, may increase your risk of giving birth prematurely before the 37th week of pregnancy. Your healthcare provider can discuss treatment risks and benefits with you.

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What Is The Long

The outlook for people with Bells palsy is usually good. Recovery time can vary depending on the severity of nerve damage.

If the nerve damage is mild, you may start seeing an improvement within 2 to 3 weeks of the initial onset of symptoms. If the nerve damage is more severe, it could take 3 to 6 months to start noticing an improvement. In rare cases, symptoms may continue to return or may be permanent.

When To Call A Professional

Treatment for Chronic Bell’s Palsy and Similar Conditions

If you have been diagnosed with Bell’s palsy, call your doctor immediately if your eye starts hurting or feels irritated. Call if your arms or legs feel weak, your vision changes, you get dizzy, have trouble swallowing, or get a headache that keeps getting worse. Contact your doctor promptly if any symptoms get worse.

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Bell Palsy From Lyme Meningitis


Figure A 10-year-old girl presented with left-sided Bell palsy as the first manifestation of Lyme disease.When she closed her eyes without smiling, her left eye remained partially open . For comparison,the patient is shown smiling with her eyes open and with her eyes closed .

LYME DISEASEThe incidence of pediatric Lyme disease is highest among children aged 5 to 9 years.1 The clinical manifestations of Lyme disease are divided into 3 stages . Early localized disease usually manifests as erythema migrans, typically at the site of the tick bite. Lyme neuroborreliosisneurological involvement caused by infection with the spirochete Borrelia burgdorferiis usually characterized as early disseminated disease. Common features of early disseminated disease include headaches, seizures, meningitis, meningoencephalitis, focal neurological signs, and ataxia.2 Manifestations of late disease may occur months to years after the initial infection if antimicrobial therapy was not given in the early stages of disease.1

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Key Points For Healthcare Providers

  • In patients with facial palsy who are unable to close one or both eyes, eye drops or an eye patch may be needed to prevent dry eyes.
  • Neurologic symptoms do not necessarily indicate central nervous system infection in a patient with Lyme disease.
  • Two-step serologic testing for Lyme disease is the recommended diagnostic test for neurologic Lyme disease.
  • Cerebral spinal fluid analysis is not necessary to diagnose Lyme meningitis, but can help exclude other causes of illness, such as bacterial meningitis.
  • Consider Lyme radiculoneuritis in patients who report severe limb or truncal radicular pain without preceding trauma who live in or who have traveled to Lyme-endemic areas.
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    Lyme Disease Bells Palsy And Facial Paralysis: What Is The Best Treatment Option

    There may be times when Lyme disease occurs due to a bacterial infection that can be treated with antibiotics. Or, there may be instances when other treatment options are required to address a patients symptoms. Regardless, testing is necessary to ensure a patient can receive an accurate Lyme disease diagnosis. From here, a doctor can identify a safe, effective treatment designed to deliver long-lasting symptomatic relief.

    Appropriate treatment forLyme disease Bells palsyor other facial palsy symptoms is crucial. Inone study, researchers found patients dealing with Lyme disease-related facial palsy faced a higher risk of severe long-term outcomes when treated using the same regimen as Bells palsy patients.

    Those who experience facial paralysis symptoms should consult with a doctor immediately. At this time, a doctor can determine if these symptoms are related to facial paralysis. The doctor also can find out if a patient is coping with Bells palsy or facial palsy and treat the condition accordingly.

    Implications For Research And Practice

    A Guide To Quick Recovery From Bell

    Bilateral lower motor neurone facial weakness and mononeuritis multiplex ring alarm bells for Lyme disease, but unilateral lower motor neurone facial weakness does not necessarily. It is important, therefore, to consider the clues to the different diagnoses. Bells palsy typically presents with an acute onset to a maximum within 72 hours. About 50% of patients have a mild-to-moderate post-auricular pain , with altered taste in 35%. In 30% a dry eye is noticed, and in 20% a dry mouth, due to parasympathetic involvement. Patients with Lyme disease with facial palsy may have noticed a tick bite a hard-bodied tick attachment with or without engorgement is particularly relevant. And 90% will experience a transient rash, erythema migrans, 240 days after exposure. Approximately 7% will feel generally unwell, and arthralgia has also been reported.,, Although the diagnosis is clinical, serological testing may be useful, particularly paired blood samples taken at a 4-week interval, to allow for seroconversion.

    Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas mapped in , particularly in the summer months, but increasingly also in winter as the climate changes. Consider testing for Lyme disease in younger patients with Bells palsy. Public health measures to reduce tick bites may further help to prevent the contraction of Lyme disease and the development of facial palsy.

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    Clinical Practice Guidelines By The Infectious Diseases Society Of America American Academy Of Neurology And American College Of Rheumatology : 2020 Guidelines For The Prevention Diagnosis And Treatment Of Lyme Disease

    Clinical Infectious Diseases, Volume 72, Issue 1, 1 January 2021, Pages e1-e48, 30 November 2020

    Paul M Lantos, Jeffrey Rumbaugh, Linda K Bockenstedt, Yngve T Falck-Ytter, Maria E Aguero-Rosenfeld, Paul G Auwaerter, Kelly Baldwin, Raveendhara R Bannuru, Kiran K Belani, William R Bowie, John A Branda, David B Clifford, Francis J DiMario, Jr, John J Halperin, Peter J Krause, Valery Lavergne, Matthew H Liang, H Cody Meissner, Lise E Nigrovic, James J Nocton, Mikala C Osani, Amy A Pruitt, Jane Rips, Lynda E Rosenfeld, Margot L Savoy, Sunil K Sood, Allen C Steere, Franc Strle, Robert Sundel, Jean Tsao, Elizaveta E Vaysbrot, Gary P Wormser, Lawrence S Zemel

    For the full document, including complete tables and references, please visit the Oxford University Press website.

    A summary guideline for clinicians may be found here.

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    Treatment Of Erythema Migrans Rash

    People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease. Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions. For treating other manifestations, see www.cdc.gov/Lyme/treatment.

    Lyme Disease treatment regimens

    30 mg/kg per day orally, divided into 2 doses 500 mg per dose 14

    *When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize adverse effects, including infectious diarrhea and antimicrobial resistance.

    NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.

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    Bell’s Palsy: Treatment Guidelines

    Article notesCopyright and License informationDisclaimerFor correspondence: Dr. J K. Murthy,Copyright

    The most common cause of acute onset unilateral peripheral facial weakness is Bell’s palsy. The incidence of Bell’s palsy is 20-30 cases for 100,000 and accounts for 60-70% of all cases of unilateral peripheral facial palsy. Either sex is affected equally and may occur at any age, the median age is 40 years. The incidence is lowest under 10 years of age and highest in people over the age of 70. Left and right sides are affected equally.

    What Are The Symptoms Of Bells Palsy

    Moving With Bilateral Bells Palsy & Chronic Lyme Disease

    Symptoms of Bells palsy tend to come on suddenly and reach peak severity within 48 to 72 hours. Some people develop mild symptoms. Others experience total paralysis.

    Symptoms start to gradually improve in three weeks. Up to 80% of people fully recover and show no signs of Bells palsy within three months.

    In addition to facial drooping, signs of Bells palsy include:

    • Difficulty speaking, eating or drinking.

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    Etiology And Differential Diagnosis

    Bells palsy is believed to be caused by inflammation of the facial nerve at the geniculate ganglion, which leads to compression and possible ischemia and demyelination. This ganglion lies in the facial canal at the junction of the labyrinthine and tympanic segments, where the nerve curves sharply toward the stylomastoid foramen. Classically, Bells palsy has been defined as idiopathic, and the cause of the inflammatory process in the facial nerve remains uncertain. Recently, attention has focused on infection with herpes simplex virus type 1 as a possible cause because research has found elevated HSV-1 titers in affected patients. However, studies have failed to isolate viral DNA in biopsy specimens, leaving the causative role of HSV-1 in question.4,5

    Many conditions can produce isolated facial nerve palsy identical to Bells palsy. Structural lesions in the ear or parotid gland can produce facial nerve compression and paralysis. Other causes of peripheral nerve palsies include Guillain-Barré syndrome, Lyme disease, otitis media, Ramsay Hunt syndrome , sarcoidosis, and some influenza vaccines. Although these conditions can present as isolated facial nerve palsies, they usually have additional features that distinguish them from Bells palsy.

    Gradual onset mental status changes history of cancer

    Symptoms Of Lyme Disease

    One of the hallmarks of Lyme disease is a rash in a target-shape. The rash may develop within days of being bitten. It may also move around the body. It is not uncommon for the rash to go unnoticed, and some individuals may not develop a rash at all. Other symptoms of the disease include:

    • Facial weakness

    Symptoms of Lymes may begin a few days after being bitten or it may take weeks before any symptoms appear. Symptoms vary greatly from patient to patient.

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    How Is Bells Palsy Managed Or Treated

    Bells palsy improves without treatment. Still, your healthcare provider may recommend one or more of these therapies for symptom relief and a faster recovery:

    • Oral corticosteroids, such as prednisone, decrease nerve swelling and may help you regain facial movement faster. This treatment is most effective when you start it within 48 hours of noticing symptoms.
    • Antiviral medications, such as acyclovir for herpes, may speed recovery, although its unclear how much benefit they provide. This treatment works best when combined with oral corticosteroids.
    • Eye care is very important. Eyedrops, including artificial tears, soothe dry, irritated eyes. If your eyelid wont close, you may need to wear an eye patch to protect the eye from irritants and injuries.
    • Functional facial plastic surgery procedures are options for people who dont recover to help correct facial asymmetry and assist with eyelid closure.

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    A Patient With Siadh Urinary Retention Constipation And Bells Palsy Following A Tick Bite

    New surgical technique for Bell


    Introduction. Lyme disease is the most common vector borne disease in the USA caused by the bacterium Borrelia burgdorferi. If untreated, Lyme disease can cause a variety of secondary symptoms often difficult to interpret. Some of the rare manifestations of Lyme disease include SIADH-like syndrome, enteroparesis, and urinary retention. Case Report. A 69-year-old male presented with anorexia and constipation and was found to have hyponatremia. Several days after admission, Bells palsy developed and he experienced urinary retention requiring catheterization. Lyme disease was confirmed on serology, and he recalled a rash on his elbow four weeks prior. Ceftriaxone was started and the patient improved he had multiple bowel movements after receiving laxatives and the Foley catheter was removed serum sodium normalized with fluid restriction. He was discharged home and was well with symptoms completely resolved at three-month follow-up. Discussion. There should be a high alert of atypical presentation of this common tick bite associated infection. Review of the literature revealed ten similar cases, but only three of these patients were reported to have a combination of SIADH, urinary retention, and enteroparesis.

    1. Introduction

    2. Case Report

    3. Discussion

    Conflicts of Interest

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