Key considerations
- Early diagnosis: it is important to quickly diagnose and treat Lyme disease for effective recovery from Lyme related facial palsy.
- Misdiagnosis: facial palsy caused by Lyme disease is often mistaken for Bell’s palsy which is often linked to viral infections.
- Common in children: Lyme disease is a common cause of facial nerve paralysis in children.
- Limited medical awareness: knowledge is improving but doctors may not suspect Lyme disease particularly without a known tick bite or erythema migrans (EM) rash.
Treatment
- Antibiotics: it is important to quickly take the correct dose and course of antibiotics for Lyme disease. It is not necessary to wait for a positive Lyme disease test result before treating. Lyme disease tests have limitations which can make diagnosis more difficult.
- Steroids: these are typically used for Bell’s palsy but may not be appropriate for Lyme related facial palsy.
Facial palsy case studies
Our case studies demonstrate the importance of considering Lyme disease when diagnosing and treating patients with facial nerve palsy. Delayed treatment can lead to wider and more severe symptoms that can be harder to treat.
My Lyme story: Ella
Prompt diagnosis and treatment led to a relatively quick recovery and positive outcome.
Ella developed facial palsy due to Lyme disease following an unknown tick bite. She had no other symptoms; no fever, no rash, and no joint pain.
Although initially treated for a suspected unspecified allergic reaction, doctors at A&E knew that facial palsy in children is often linked to Lyme disease. As soon as the facial palsy became more obvious they quickly started Ella on the correct antibiotics for Lyme. They did not delay to wait for Lyme disease blood test results. After about three weeks of antibiotics Ella’s face had completely recovered and she had returned to good health.
Read My Lyme story: Ella
My Lyme story: Danielle
A delay in receiving the correct diagnosis and antibiotics led to worsening symptoms, prolonged treatment, higher risk of an uncertain outcome, and months of ill health.
10-year-old Danielle developed a spreading rash that did not look like a typical bull’s-eye shaped erythema migrans (EM) rash. This was initially misdiagnosed and treated as ringworm. There was no knowledge of a previous tick bite.
She then developed facial asymmetry and was rushed to A&E but unfortunately the service was very busy and she was unable to be seen. The following morning the family’s GP mistakenly diagnosed a virus as the cause as Danielle had an atypical rash, a high temperature and was not feeling well.
It was only by chance that friends of the family mentioned Lyme disease, and the risk was considered. Danielle was taken back to A&E and received the correct diagnosis following another very long wait. Unfortunately she was then given a hospital prescription for the wrong antibiotic, which the local pharmacy was also unable to provide. This led to another GP appointment and the correct antibiotic, amoxicillin, but this was prescribed at too low a dose.
This error was only realised when Danielle’s parents read LDUK’s facial palsy information which outlined the correct antibiotic dosage for Lyme disease. Yet another appointment was arranged with the GP to obtain the correct treatment. Meanwhile Danielle’s facial palsy worsened and she felt increasingly unwell, missing 6 days of school.
Danielle’s parents were concerned at the lack of ongoing NHS support so they took Danielle to an osteopath, who suggested various exercises including balloon blowing, to re-strengthen her cheek muscles. Throughout her illness Danielle tired quickly and had awful debilitating headaches on a regular basis to the extent that she even had an MRI to rule out underlying conditions. Luckily she eventually regained her health but it took months for her to look and feel normal again.
Read Patient case study 2: child with infected tick bite and facial palsy