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Sunday, August 28, 2011

[AlternativeAnswers] Clinical characteristics and cerebrospinal fluid parameters in patients with pe


Clinical characteristics and cerebrospinal fluid parameters in
patients with peripheral facial palsy caused by Lyme neuroborreliosis
compared with facial palsy of unknown origin (Bell's palsy).

Bremell D, Hagberg L

BMC Infect Dis 2011 08 10; 11 (1): 215

ABSTRACT: BACKGROUND: Bell's palsy and Lyme neuroborreliosis are the two
most common diagnoses in patients with peripheral facial palsy in areas
endemic for Borrelia burgdorferi. Bell's palsy is treated with
corticosteroids, while Lyme neuroborreliosis is treated with
antibiotics. The diagnosis of Lyme neuroborreliosis relies on the
detection of Borrelia antibodies in blood and/or cerebrospinal fluid,
which is time consuming. In this study, we retrospectively analysed
clinical and cerebrospinal fluid parameters in well-characterised
patient material with peripheral facial palsy caused by Lyme
neuroborreliosis or Bell's palsy, in order to obtain a working diagnosis
and basis for treatment decisions in the acute stage.

METHODS: Hospital records from the Department of Infectious Diseases,
Sahlgrenska University Hospital, for patients with peripheral facial
palsy that had undergone lumbar puncture, were reviewed. Patients were
classified as Bell's palsy, definite Lyme neuroborreliosis, or possible
Lyme neuroborreliosis, on the basis of the presence of Borrelia
antibodies in serum and cerebrospinal fluid and preceding erythema migrans.

RESULTS: One hundred and two patients were analysed; 51 were classified
as Bell's palsy, 34 as definite Lyme neuroborreliosis and 17 as possible
Lyme neuroborreliosis. Patients with definite Lyme neuroborreliosis fell
ill during the second half of the year, with a peak in August, whereas
patients with Bell's palsy fell ill in a more evenly distributed manner
over the year. Patients with definite Lyme neuroborreliosis had
significantly more neurological symptoms outside the paretic area of the
face and significantly higher levels of mononuclear cells and albumin in
their cerebrospinal fluid. A reported history of tick bite was uncommon
in both groups.

CONCLUSIONS: We found that the time of the year, associated neurological
symptoms and mononuclear pleocytosis were strong predictive factors for
Lyme neuroborreliosis as a cause of peripheral facial palsy in an area
endemic for Borrelia. For these patients, we suggest that ex-juvantibus
treatment with oral doxycycline should be preferred to early
corticosteroid treatment.

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