Thank you for your interest in learning about facial palsy caused by Lyme disease.
Lyme disease can, in some cases, impact the facial nerves and cause facial palsy. It is important that facial paralysis caused by Lyme disease is diagnosed promptly to minimise any delay in receiving antibiotic treatment.
Key points
- Lyme disease is a bacterial infection that can be spread to humans by infected ticks.
- Early diagnosis and treatment can lead to a resolution for many patients.
- Late or missed diagnosis can result in persistent and debilitating symptoms.
- Lyme disease is the most common cause of facial nerve paralysis in children and is caused by the tick-borne spirochete of the Borrelia species (Penrose et al:2018).
- Facial palsy can be misdiagnosed as Bell’s Palsy, which risks not identifying the infectious cause of the condition and antibiotic treatment being delayed (Cooper et al:2017).
- A research project looking into high frequency of paediatric facial palsy due to Lyme disease in a geographically endemic region concluded that in areas endemic with Lyme disease, this should be considered as the likely cause of facial nerve paralysis in children until proven otherwise. (Munro et al:2020).
- The study by Penrose et al also concluded that clinicians should be considering Lyme disease as their differential in children presenting with facial palsy.
- The NICE guideline relating to Lyme disease (NICE: 2018) states that infected ticks can be found throughout the UK, although some areas appear to have higher prevalence.
View reference links and research paper by Julia Knight RN Child (Retired), BSc (Nursing), BMedSci (Specialist Community Nursing & Healthcare Practice), Press and Community Outreach Manager and Trustee, Lyme Disease UK.
Facial palsy case study
Danielle is ten years old and lives in Berkshire. This is her story of contracting Lyme disease with facial palsy, written by Danielle’s mum, Jenna Stalker*. Jenna writes:
“It was the facial asymmetry that led us to getting her checked out. Later when piecing things together we realised the rash she had developed on her shoulder was from a tick bite. As it didn’t have the typical bull’s-eye presentation, it was initially misdiagnosed and treated as ringworm).
We were worried it was signs of a stroke. We didn’t get seen on our first trip to A&E as after 5 hour wait, an emergency came in and we were advised to go home at 2am. We had a follow up GP appointment in the morning, the doctor diagnosed her symptoms as a virus (the spreading rash and the facial palsy together, along with high temperature and not feeling right). We were given a further prescription for cream for the rash.
It was only when my mum was discussing her concerns with a colleague (nurses in various community roles), that the potential of it being Lyme disease was raised. My husband took her back to A&E and after 9 hours got a diagnosis of Lyme disease.
They sent her away with the prescription for the adult medication (adjusted dose), which our pharmacy couldn’t fill. I went to GP surgery and the lead doctor prescribed a standard dose of amoxicillin. It was only during my own research that night that I found the LDUK article (www.lymediseaseuk.com/clinicians/facial-palsy-resources/) about treatment and higher doses of antibiotics that are needed for Lyme disease. We went back to doctors again and finally got the right dose prescription. In the meantime Danielle’s face got worse, and she was feeling very poorly. She ended up with 6 days off school.
Her face worried us as the NHS just left us to it. We went to our osteopath, she gave us various exercises to do including balloon blowing, to re-strengthen her cheek muscles. I really feel the NHS needs more follow up, as it took months afterwards for her to look normal again. She would also tire quickly and had awful debilitating headaches on a regular basis to the extent she even had an MRI to rule out any underlying conditions.”
Danielle is thankfully now fully recovered 10 months later.
Photos of spreading rash taken over 3 week period. Palsy occurred in week 4.
*Jenna and Danielle have given permission to include photos to show Danielle’s facial palsy and rashes.
Why Lyme disease infections can be missed or under-treated
- The possibility of a Lyme disease infection not being considered as a common cause of facial palsy.
- The erythema migrans (Lyme rash) not being present or recognised.
- Being prescribed an incorrect dose or duration of antibiotics and/or a second course not considered. Antibiotics for Lyme disease in children are given in much higher doses than for other childhood infections.
- Relying on a positive Lyme disease blood test for diagnosis before treating with antibiotics, or testing too early which can give a false negative result.
More facial palsy case studies
- My Lyme Story: Ella
- Clinicians’ Hub – Patient Case Studies (Case Study 2, 8 and 11)
Further resources
- The resource below explains the experiences of children with facial nerve paralysis caused by Lyme disease. It also provides details on diagnosis, treatment, and ongoing support for patients. Learn more by reading the full paper.
- Further information is also available from Facial Palsy UK.
