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Facial Palsy: An Important Clue Pointing To Neurological Lyme Disease

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

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:

  • Cranial palsy
  • Meningitis
  • 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/

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:

  • Fever
  • Arthritis
  • 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.

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.

Also Check: Lyme Disease Symptoms Mayo Clinic

Bell’s Palsy: Treatment Guidelines

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

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 Causes Bells Palsy

Bells palsy Homeopathic Treatment Idiopathic facial paralysis

Various viruses may trigger Bells palsy. The condition occurs when swelling or inflammation temporarily puts pressure on the nerve that controls facial muscles. This pressure impairs the function of the nerve making it difficult for you to control facial muscles or expressions. As the inflammation subsides, the nerve starts to function again. It may take several months for symptoms to go away.

Also Check: What Lab Test For Lyme Disease

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.
  • A Tick Regurgitates The Spirochete From Its Intestinal Tract Into The Bloodstream Of The Patient And Causes Infection

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    A 6-year-old boy presented to the emergency room in July with a history of right facial weakness for one day, headache and neck stiffness.

    During the two previous weeks, he had been lethargic and complaining of headache and neck stiffness. He also had several episodes of vomiting. His pediatrician diagnosed otitis externa 10 days prior to his emergency room visit and treated him with eardrops. The child had no history of fever, rash, joint pain or swelling. He had no change in vision, weakness or seizures. His appetite was decreased, and he had lost three pounds during the course of his illness.

    The patient lives in a wooded area in Maryland, and had been camping in New Jersey one month prior to admission. He had no known tick bites. Of note, the family dog tested positive for Lyme disease and the patients 3-year-old sister was treated for Lyme disease one year ago.

    He was diagnosed with early disseminated Lyme disease with facial nerve palsy, meningitis and secondary erythema migrans . He was treated with ceftriaxone for 30 days and symptoms resolved completely within two weeks of initiating antibiotic therapy. Serum Lyme immunoglobulin M was positive at 7.88 serum Lyme IgG was positive at 2.82 CSF Lyme IgM was positive at 1:2 and CSF Lyme IgG was < 1:4 . Lyme polymerase chain reaction from the CSF was negative.




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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.


    Schedule A Lyme Disease And Bells Palsy Treatment Consultation With Dr Azizzadeh

    Moving With Bilateral Bells Palsy & Chronic Lyme Disease

    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.

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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.

    Signs Of Lyme Disease

    Lyme disease symptoms may begin anywhere from days to weeks following exposure and often vary greatly between individuals. Many patients do not even recall being bitten by a tick.

    The most common symptom is a target-like rash that moves around the body. However, many patients do not notice or develop a rash. In these cases, laboratory testing is needed for a diagnosis.

    Other symptoms might include fever, chills, headache, fatigue, neck stiffness or muscle aches. In late stages, some patients also develop arthritis.

    Because Lyme disease is caused by bacteria that can affect the nervous system, it can sometimes cause dysfunction of the facial nerve .

    About five percent of patients with Lyme disease will develop some degree of sudden facial weakness , where one or both sides of the face droop. Known as Lyme disease-associated facial palsy, this tends to occur seven to 21 days after tick exposure in infected patients. Anyone who experiences sudden facial palsy should be urgently assessed by a physician to establish the appropriate diagnosis.

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    Clinical Questions And Evidence Review

    An initial list of relevant clinical questions for these guidelines was created by the whole panel for review and discussion. The final set of clinical questions was approved by the entire committee. All outcomes of interest were identified a priori and explicitly rated for their relative importance for decision making. Each clinical question was assigned to a pair of panelists.

    Evidence summaries for each question were prepared by the technical team from Tufts Medical Center. The risk of bias was assessed by the technical review team using the Cochrane risk of bias tool for randomized controlled trials , the Newcastle-Ottawa scale for nonrandomized studies and QUADAS-2 tool for diagnostic test accuracy studies . The certainty in the evidence was initially determined for each critical and important outcome, and then for each recommendation using the GRADE approach for rating the confidence in the evidence . Evidence profile tables and quality of evidence were reviewed by the guideline methodologists . The summaries of evidence were discussed and reviewed by all committee members and edited as appropriate. The final evidence summaries were presented to the whole panel for deliberation and drafting of recommendations. Literature search strategies, PRISMA flow diagrams detailing the search results, data extraction and evidence profiles tables, and additional data, such as meta-analysis results when appropriate, can be found in the supplementary materials .

    Incidence And Characteristics Of Lyme Neuroborreliosis In Adult Patients With Facial Palsy In An Endemic Area In The Netherlands

    Pin on Lyme Autism

    Published online by Cambridge University Press: 21 March 2019

    Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The Netherlands
    B. van Kooten
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Neurology, Gelre Hospital, Apeldoorn, The Netherlands
    Y.M. Vermeeren
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
    T.D. Bruintjes
    Department of Otorhinolaryngology, Gelre Hospital, Apeldoorn, The Netherlands
    B.C. van Hees
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Medical Microbiology and Infection Prevention, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
    R.A. Bruinsma
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Pediatrics, Gelre Hospital, Apeldoorn, The Netherlands
    G.W. Landman
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
    T. van Bemmel
    Affiliation:Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The NetherlandsDepartment of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
    T.P. Zomer*
    Lyme Centre Apeldoorn, Gelre Hospital, Apeldoorn, The Netherlands

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    Are There Different Lyme Disease Bells Palsy And Facial Paralysis Symptoms

    A common symptom of Lyme disease that causes Bells palsy is weakness on one side of the face. Comparatively, Lyme disease related to facial paralysis can result in weakness on one or both sides of the face.

    Also, Lyme disease linked to facial paralysis can cause fever, chills, neck stiffness, and other flu-like symptoms. On the other hand, Lyme disease related to Bells palsy is unlikely to cause any of these symptoms.

    How Is Bell’s 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 it’s 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 don’t recover to help correct facial asymmetry and assist with eyelid closure.

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    Etiology And Differential Diagnosis

    Bell’s 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, Bell’s 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 Bell’s 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 Bell’s palsy.

    Metastases, primary brain Gradual onset mental status changes history of cancer

    How Does Bells Palsy Affect Pregnancy

    Treatment for Chronic Bell’s Palsy and Similar Conditions

    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 Bells Palsy

    Bells palsy causes temporary paralysis, or palsy, of facial muscles. It occurs when a condition, such as a viral infection, causes inflammation and swelling of the seventh cranial nerve .

    With Bells palsy, your face droops on one side or, rarely, both sides. You may have a lopsided smile, or an eyelid that wont close. These effects typically last several months and go away without treatment. The condition gets its name from Sir Charles Bell, a Scottish surgeon who first described it during the 19th century.

    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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    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.

    Disclosure And Management Of Potential Conflicts Of Interest


    The Lyme conflict of interest review group consisting of 2 representatives from IDSA, AAN, and ACR were responsible for reviewing, evaluating, and approving all disclosures. All members of the expert panel complied with the consensus IDSA/AAN/ACR process for reviewing and managing conflicts of interest, which required disclosure of any financial, intellectual, or other interest that might be construed as constituting an actual, potential, or apparent conflict, regardless of relevancy to the guideline topic. Thus, to provide transparency, IDSA/AAN/ACR required full disclosure of all relationships. The assessment of disclosed relationships for possible COI by the IDSA/AAN/ACR review group was based on the relative weight of the financial relationship and the relevance of the relationship . For more information on allowable and prohibited relationships, please review Table 1 and Table 2. In addition, the IDSA/AAN/ACR adhered to Section 7 of the Council for Medical Specialty SocietiesââCode for Interactions with Companiesâ . The COI review group ensured that the majority of the panel and each cochair was without potential relevant conflicts . Each of the cochairs and all members of the technical team were determined to be unconflicted. See the notes section for disclosures reported to IDSA/AAN/ACR.

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