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Can Lyme Disease Cause Bell’s Palsy


Abnormal Sensations In The Limbs

2-Minute Neuroscience: Bell’s Palsy

A possible complication of Lyme disease is peripheral neuropathy, which signals dysfunction in the communication between nerves. Lyme-related neuropathy can cause odd sensations in different parts of the body, especially the limbs. Some people feel sharp, stabbing pains, burning sensations, tingling, and even numbness.These symptoms are common to many diseases, which is one more reason affirmative Lyme disease diagnoses are often delayed.

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.

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Getting The Right Treatment

Lyme disease-associated facial palsy may look a lot like Bells palsy another cause of sudden facial weakness. But the two conditions are not the same.

Though more research is needed, a recent study from Mass. Eye and Ear suggests that patients with Lyme disease-associated facial palsy might develop worse long-term outcomes when treated with the same regimen used to treat patients with Bells palsy.

Since Lyme disease is a bacterial infection, it requires antibiotic therapy. Bells palsy is believed to be caused by a virus, and therefore is typically treated with corticosteroids and antivirals.

In some cases of acute facial palsy, physicians will prescribe antibiotics, corticosteroids and antiviral medications while awaiting lab results for Lyme disease, said Dr. Jowett. While good evidence supports the use of corticosteroids in Bells palsy, their role as an add-on therapy for Lyme disease-associated facial palsy is currently unclear.

Patients with Lyme disease-associated facial palsy and Bells palsy often experience different symptoms:

  • Patients with Bells palsy typically feel fine, whereas patients with Lyme disease-associated facial palsy often have flu-like symptoms. While changes in taste, ear pain and pain behind the ear occur frequently in both conditions, facial weakness that is accompanied by severe headaches, fever or chills, neck stiffness, severe fatigue or lethargy, back or abdominal pain or muscle aches is highly suggestive of Lyme disease.
  • Can You Have Lyme Meningitis Without Knowing


    If a person does not know that they received a tick bite and does not develop symptoms at an early stage, they may not realize that they have Lyme meningitis. It is also possible that a person may not test positive for the condition despite having it. However, in time, symptoms are likely to develop. As soon as a person notices symptoms, they should speak with a doctor.

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    Achy Stiff Or Swollen Joints

    Joint pain and stiffness, often intermittent, are early Lyme symptoms. Your joints may be inflamed, warm to the touch, painful, and swollen. You may have stiffness and limited range of motion in some joints .

    Pain may move around. Sometimes your knees may hurt, whereas other times its your neck or your heels. You may also have bursitis . Bursae are the thin cushions between bone and surrounding tissue.

    The pain may be severe, and it may be transitory. More than one joint may be affected. Most often the large joints are involved .

    People often attribute joint problems to age, genetics, or sports. Lyme should be added to that list, as these statistics indicate:

    • One study estimates that 80 percent of people with untreated Lyme have muscle and joint symptoms .
    • Fifty percent of people with untreated Lyme have intermittent episodes of arthritis .
    • Two-thirds of people have their first episode of joint pain within six months of the infection .
    • Use of anti-inflammatory drugs may mask the actual number of people with joint swelling .


    Joint pain that comes and goes, or moves from joint to joint, could be a sign of Lyme.

    Who Is At Risk

    Bells palsy affects about 40,000 people in the United States every year. It can affect anyone of any gender and age, but its incidence seems to be highest in those in the 15- to 45-year-old age group. Risk factors for Bells palsy include pregnancy, preeclampsia, obesity, hypertension, diabetes, and upper respiratory ailments.

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    What Is Bell’s Palsy

    Bell’s palsy, also known as idiopathic facial palsy, is a form of temporary facial paralysis or weakness on one side of the face. It results from dysfunction of cranial nerve VII which directs the muscles on one side of the face, including those that control eye blinking and closing and facial expressions such as smiling. The facial nerve also carries nerve impulses to the tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear. The facial nerve also transmits taste sensations from the tongue.

    Bell’s palsy is the most common cause of facial paralysis, although its exact cause is unknown. Generally, Bell’s palsy affects only one side of the face however, in rare cases, it can affect both sides. Symptoms appear suddenly over a 48 – 72-hour period and generally start to improve with or without treatment after a few weeks, with recovery of some or all facial function within six months. In some cases, residual muscle weakness lasts longer or may be permanent.

    What Are The Complications Of Bell’s Palsy

    Bells Palsy (Facial Paralysis) | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

    Bells palsy usually resolves in time and causes no long-term complications. However, during the illness most people with Bells palsy are unable to close their eye on the affected side of their face. It is, therefore, important to protect the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched.

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    What Questions Should I Ask My Doctor

    If you have Bells palsy, you may want to ask your healthcare provider:

    • Why did I get Bells palsy?
    • What is the best treatment for Bells palsy?
    • Are there any treatment side effects?
    • When will these symptoms go away?
    • Can I get Bells palsy again?
    • Can therapies like physical therapy or massage therapy speed recovery?
    • Should I look out for signs of complications?

    A note from Cleveland Clinic

    If you get Bells palsy, you may be embarrassed by the way your face looks. Fortunately, these symptoms gradually improve with time. See your healthcare provider when symptoms first appear. Corticosteroid treatments can speed recovery if you start them within 48 hours of noticing symptoms. Your provider can also rule out other, more serious conditions that cause facial paralysis.

    Last reviewed by a Cleveland Clinic medical professional on 05/29/2020.


    When To Call A Professional

    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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    Early Symptoms Of Lyme Disease

    Symptoms of Lyme disease in humans can be vague, and chances are you have no idea youve been bitten by an infected tick until symptoms surface.

    Ticks secrete an anesthetic that makes their bites painless, explains Christine Green, MD, a family physician in Mountain View, California, and a member of the Bay Area Lyme Foundations scientific advisory board. Plus, theyre tiny. A young, immature tick, called a nymphthe stage of development during which these bloodsuckers are most likely to transmit Lyme diseaseis roughly the size of a pinhead when it latches on, so you dont know its there, she tells Health.

    According to the CDC, the incubation period for Lymein other words, the time between a persons exposure to Borrelia bacteria and symptom onsetranges from three to 30 days. The main symptoms of Lyme disease in the early days and weeks after infection can include:

    • Fever

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    What Are The Symptoms Of Lyme Disease


    Early symptoms

    • Approximately three to thirty days after the person has been bitten by an infected tick, the bacteria disseminate from the bite site into the surrounding skin tissue. This may result in an expanding pink or red rash surrounding the bite area. A Lyme disease rash is usually greater than five centimetres in diameter and may be circular, oval or irregular shaped. It may be solid in colour or like a bulls-eye on a dartboard. The rash expands over a period of days to weeks and, in some cases, can reach up to seventy five centimetres in diameter. The rash may not be observed if it appears under body hair, under hair on the scalp or in another inaccessible place. Darker skin may make it difficult to identify a rash and paler rashes can be overlooked even on lighter skin. Even without treatment a Lyme disease rash will resolve but a lack of treatment can allow the disease to progress to more serious and debilitating symptoms.
    • You may develop flu-like symptoms, joint pain or tiredness.

    Later symptoms

    If left untreated, then several months or years later you may experience the following:

    • Muscle pain.
    • Joint pain and swelling of the joints.
    • Neurological symptoms, such as a temporary paralysis of one side of your face.
    • It may also trigger symptoms, such as chronic fatigue syndrome or fibromyalgia. This is known as chronic Lyme disease, but further research into this area is required.

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    What Research Is Being Done

    The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use the knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.

    The NINDS conducts and supports an extensive research program of basic science to increase understanding of how the nervous system works and what causes the system to sometimes go wrong, leading to dysfunction. Part of this research program focuses on learning more about the circumstances that lead to nerve damage and the conditions that cause injuries and damage to nerves.

    For example, in one research project, scientists are studying two genes to identify the molecular mechanisms involved in the regeneration of nerve projections to their original targets. An understanding of how to regenerate peripheral nerves may lead to ways to prevent nerve damage and injuries from occurring. Additional projects seek to identify the mechanisms and consequences of neuroinflammation on peripheral nerve function.

    Knowledge gained from this research may help scientists find the definitive cause of Bell’s palsy, leading to the discovery of new effective treatments for the disorder.

    Diagnosis Of Bell Palsy

    • A doctor’s evaluation

    • Sometimes various tests, depending on the suspected cause

    Facial nerve palsy can usually be diagnosed and distinguished from other disorders based on symptoms. For example, facial nerve palsy can be distinguished from a stroke because a stroke usually causes weakness only in the lower part of one side of the face rather than in the entire side of the face. People who have had a stroke can close the eyes tightly and wrinkle the brow. Also, a stroke typically causes weakness of an arm and/or a leg.

    Doctors can usually distinguish Bell palsy from other, less common disorders that cause facial nerve palsy . These other disorders typically cause different symptoms, and in many of them, symptoms develop more slowly. Thus, if doctors are not certain that Bell palsy is the cause or if symptoms developed gradually, tests are done. These tests include

    • Blood tests

    • X-rays

    • Magnetic resonance imaging or computed tomography of the brain

    For example, blood tests may be done to check for other causes of facial nerve palsy such as Lyme disease and a blood test and chest x-ray may be done to check for sarcoidosis. Usually, doctors can exclude other causes based on the persons symptoms and results of these tests.

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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.

    What Is Neurologic Lyme Disease

    The Difference Between Bell’s Palsy and Stroke Symptoms

    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.

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    What Causes Lyme Disease

    • Lyme disease is caused by a group of closely-related spirochaetal bacteria species, together known as Borrelia Burgdorferi sensu lato. These bacteria are carried in the blood of various birds and mammals .
    • If a tick bites an animal that has the bacteria, then the tick will also become infected. If an infected tick bites a human, then the infection can be passed on to the human as the tick feeds on their blood.
    • Ticks are small and their bite painless so may go unnoticed.
    • Tick saliva has several functions. It helps to numb the bite area so that the host cant feel it feeding, and to prevent inflammation and keep the blood flowing. Saliva is introduced continuously during the feeding process. Borrelia bacteria are transmitted along with the ticks saliva. The longer the tick remains attached, the more likely it is for a person to become infected. Due to the small size of ticks and the anaesthetic properties of their saliva, not all people with Lyme disease remember being bitten.
    • The bacteria move through the skin, into the bloodstream and the lymphatic system .
    • The bacteria that cause Lyme disease can damage joints and the nervous system including the facial nerve.
    • If the facial nerve is damaged, then the infected person may experience weakness or paralysis of the facial muscles, usually on one side of the face. The medical term for this is facial palsy.
    • Symptoms will reveal themselves in the mid- to late stage of the disease.

    Can You Get Bells Palsy More Than Once

    Its unusual to get Bells palsy more than once in a lifetime, but it can happen. A recurrence is most likely within two years of the first incident. The facial nerve palsy may affect the same side of your face or the opposite side. Youre more at risk for a recurrence if you have a family history of the disease.

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    What Are The Symptoms Of Bells Palsy

    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.
    • Drooling.

    How This Fits In


    Lyme disease causes distressing symptoms including facial palsy, which is often misdiagnosed as Bells palsy. There has been a call for epidemiological data concerning Lyme disease, which is currently lacking. If identified early, > 95% of patients with Lyme disease can expect a cure. A heightened awareness of risk may facilitate appropriate prophylaxis, diagnosis, and treatment. This study found Lyme disease is commoner in certain areas and in the summer months, but increasingly, as the climate changes, also in winter. Testing for Lyme disease in younger patients with Bells palsy should be considered.

    The diagnosis of Lyme disease tended to be in the less deprived half of the population compared with Bells palsy . Bells palsy diagnoses were spread throughout the year with the exception of March. Lyme disease diagnosis showed a trend towards the summer months .

    Seasonal variation in diagnoses of Bells palsy and Lyme disease.

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