Incidence And Characteristics Of Lyme Neuroborreliosis In Adult Patients With Facial Palsy In An Endemic Area In The Netherlands
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
- *
Diagnosis Of Lyme Disease
Lyme disease has the uncanny ability to mimic other conditions, as well as lay dormant in the body in areas where it can thrive without causing an immune response. These tactics can make diagnosing facial palsy as a Lyme disease repercussion much more difficult.
To ensure that a patient with facial palsy is getting the right treatment, tests will need to be done to rule out certain conditions, and medical history will be taken into account. When Lyme disease is found to be the culprit, treatment may begin.
Image by on : Antibiotics are the only treatment available for Lyme disease.
Can Lyme Disease Cause Bells Palsy
Although Lyme disease can cause facial palsy in those suffering from late-stage or chronic illness, its not exactly the same as Bells palsy. Bells palsy is caused by inflammation and swelling of the facial nerve and causes paralysis on the side affected. In the majority of cases, Bells palsy presents with just one symptom: facial paralysis. It can also present with ear pain, though this isnt always the case.
In terms of facial palsy associated with Lyme disease, facial paralysis tends to go along with a plethora of other Lyme symptoms, such as:
- Headaches
- Neck stiffness
- Muscle and joint aches
The main difference between a typical case of Bells palsy and facial palsy caused by Lyme disease is the accompanying symptoms that present in the patient. The facial palsy in Lyme disease patients is caused by the Borrelia bacterias ability to damage nerves. It does this by attaching itself to the nerves and inflaming the area to an unsafe level. Once the inflammation has taken hold, the nerve damage begins to increase. Nerve damage associated with Lyme disease can be recovered from, but if left for too long, can lead to permanent damage in the affected area.
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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.
The Road To Recovering Facial Movement
Recovery of facial function often begins within a few weeks however, it may take up to three to four months before some Lyme disease-associated facial palsy patients see any sign of recovery and up to 18 months before recovery is complete.
While all patients with Bells palsy or Lyme disease-associated facial palsy should recover facial tone and movement on the affected side, some will develop permanent facial muscle tightness, involuntary facial movements or restricted smile excursion. These long-term side effects can be effectively treated through targeted physical therapy, Botox® injections or surgical procedures.
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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.
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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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.
How Does Lyme Disease Cause Paralysis
Tick paralysis is caused by the exposure to a neurotoxin released by tick salivary glands during a bite. The most common vectors are the American dog tick and the Rocky Mountain wood tick. Most common infection locations are the Pacific Northwest, Rocky Mountain states, and southeastern part of the United States.
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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.
Epidemiology
Diagnosis
Treatment
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.
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How Long Does Facial Palsy Last With Lyme Disease
There is no definitive cause of Bells palsy, and the disease itself can strike at any time and any age. Some cases may arise due to a viral infection, but that is not the status quo when it comes to the onset of the condition. A typical bout of Bells palsy can last anywhere from a few weeks to around six months, and in most cases it does resolve. In few patients, the condition is permanent or can recur, though this is quite uncommon.
The facial palsy that occurs with Lyme disease is a little trickier. The recovery time is almost three times the amount than with a case of Bells palsy, with some cases taking roughly 18 months to resolve. Recovery time is also dependent on how quickly treatment begins.
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Does Bells Palsy From Lyme Go Away
About 5% of Lyme sufferers experience facial palsy. It can occur within a few weeks of a bite from an infected tick. This might look like Bells palsy, but it is not the same. Facial paralysis caused by Lyme infection should not be treated the same as Bells palsy. The bacterial infection of Lyme disease is treated with antibiotics. Facial paralysis caused by early onset Lyme can go away with quick diagnosis and treatment. It might take a few weeks or a few months to fully recover from facial palsy, even after treatment of Lyme is complete.
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.
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I Have Written In The Past About How Lyme Disease Can Seem Like Other Illnesses Can Bells Palsy Be An Indicator Of Lyme Infection
Most recently, I wrote about how Lyme can be misdiagnosed as Alzheimers. Bells palsy is a relatively rare condition. There are about 200,000 known cases per year in the United States. Some cases are not as serious as others. Bells palsy results in muscle weakness in half of the face. Those suffering from the condition, might notice pain in their ear. Vision can also be affected. More often, Bells palsy results in the inability to open or close the eyelids, or control facial expressions on one side of the face. There is usually noticeable facial drooping. Bells palsy can also result in sensitivity to taste and smell. It is treated with anti-viral medication and steroids, but often resolves on its own within a few months. Bells palsy is said to rarely occur more than one time. But what if it does?
Lyme Disease And Facial Weakness: What You Should Know
Monday, Aug 6, 2018
Did you know that a tick bite can sometimes cause facial paralysis? Dr. Nate Jowett of the Facial Nerve Center at Mass. Eye and Ear breaks down Lyme disease associated-facial palsy and what you need to know to make sure you get the right treatment.
Ticks are those small, pesky bugs known for carrying Lyme disease, a bacterial infection transmitted through the bite of an infected tick. The CDC estimates that blacklegged ticks, or deer ticks, infect more than 300,000 Americans with Lyme disease each year.
Lyme disease is prevalent in New England, and it can be challenging to diagnose, said Nate Jowett, MD, a specialist in the Facial Nerve Center at Mass. Eye and Ear. Its important for those at risk to know the potential symptoms especially those who venture into wooded or grassy areas.
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Lyme Disease And Facial Nerve Palsy Treatment
Lyme disease Bells palsytreatment sometimes requires the use of antibiotics. With corticosteroids, antivirals, and other antibiotics, a patient may be able to treat acute Lyme disease facial paralysis symptoms before they cause long-lasting harm.
Other treatments that may be used to treat Lyme disease facial palsy include Botox or surgery. To determine the best course of action, it is essential to meet with a doctor. This allows a patient to receive a full medical assessment to find out if he or she is dealing with Lyme disease, then explore various treatment options.
Can Lyme Disease Cause Neurological Problems In Dogs
If Lyme disease is left untreated it can lead to damage in the kidneys, nervous system, and heart. Lyme disease affecting the kidneys is the second most common syndrome in dogs and is generally fatal. Facial paralysis and seizure disorders have been reported in the disease form affecting the nervous system.
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Can Lyme Disease Affect Your Face
If Lyme disease is caught and treated early, further complications may not arise. But for those who have been left untreated due to a lack of knowledge regarding their symptoms, it can progress significantly.
The Borrelia bacteria has a way of making its rounds throughout the body once it enters the bloodstream, and it can camp out in fibroblast cells and lymph nodes. It has the ability to hide itself in a way that decreases the chances of the immune system having a response. This means the bacteria can still thrive and have a negative effect on all the bodys systems, including the nerves that affect the face.
Image by on : Is facial palsy a symptom of Lyme disease? Yes, Lyme disease can affect nerves throughout the body, leading to facial palsy.
Other Causes Of Bells Palsy
Bells palsy is a known result of a viral infection. There is evidence to show that recurring viral infections can inflame facial nerves, and result in Bells palsy. Some of these infections include herpes simplex, chickenpox, shingles, and infectious mononucleosis. If you experience signs of Bells palsy, seek medical assistance immediately. Facial paralysis can also be caused by stroke.
See more tick and Lyme disease questions and answers:
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Can A Paramedian Stroke Cause A Thalamic Stroke
Thalamic stroke accounts for 11% of vertebrobasilar infarcts. Strokes limited to paramedian territories account for ~2235% of all thalamic infarcts, usually due to cardioembolism. Consequently, occlusion of the artery of Percheron causes a bilateral paramedian thalamic infarction with or without midbrain infarction.
Comparison With Existing Literature
Cases of Lyme disease have been rising steadily over recent years, as have diagnoses in combination with Bells palsy . This may be due to better surveillance, increased awareness of the disease, or increasing infection rates caused by travel to endemic areas. Classically, Lyme disease is associated with areas of woodland, pasture, and heath, where ticks parasitise small mammals such as field mice and voles, and larger animals such as sheep, deer, and horses. The majority of European cases are within the UK, including forested areas such as the New Forest, Exmoor, the South Downs, Thetford Forest in East Anglia, the Lake District, the Yorkshire Moors, and the Scottish Highlands, although there are also cases in the Dordogne and Eastern Europe. The maps provided in support this finding and add to them .
Previous studies have shown that approximately 10% of patients with Lyme disease develop facial palsy. The authors found that only 3.5% of patients with Lyme disease developed an associated facial palsy from 2011 to 2015, which is less than expected but many more than were seen in the general population. It is possible that some facial palsy diagnoses were not coded if a cause such as Lyme disease was identified, because Bells palsy by definition is idiopathic . Also, although all of the Bells palsies have facial palsy, some of the Bells will actually be related to undiagnosed Lyme disease.
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