Bell's & Facial Palsy

Bell's palsy and Lyme disease (neuroborreliosis) are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Lyme disease (Borrelia burgdorferi). Bell's palsy is generally treated with corticosteroids, while Lyme disease is treated with antibiotics.

The distinction must be made between the two causes of the palsy to prevent unnecessary and often harmful treatment with steroids if the palsy is actually caused by Lyme disease. Steroids are contra-indicated in people with Lyme disease, except for the rare emergency situations. Additionally, spinal taps (lumbar punctures) are not recommended for patients with Bell's palsy as the sensitivity of the tests are very poor and inconclusive.

Lyme disease blood tests have been shown to miss 75% of people with Lyme disease (under the best situations), so dependence on Lyme blood tests to confirm a diagnosis of Lyme disease should never be considered conclusive. Studies recommend first-line treatment of Bell's palsy should be doxycycline (or age/situation appropriate antibiotics) rather than corticosteroids.

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Clinical Predictors of Lyme Disease Among Children With a Peripheral Facial Palsy at an Emergency Department in a Lyme Disease Endemic Area

"Lyme disease is a frequent cause of facial palsy in children living in an endemic region. Serologic testing and empiric antibiotics should be strongly considered, especially when children present during peak Lyme disease season or with a headache."

For full article, click here.


"Lyme disease can cause facial paralysis and the same symptoms as Bells palsy. Bacteria enter the body through the skin at the site of the tick bite. Typical early symptoms of Lyme disease are a red ring around the site of the bite and flu-like symptoms. Unfortunately these symptoms do not always appear. The early symptoms will pass, but administration of an antibiotic as early as possible is important to avoid serious problems later. Without an antibiotic the bacteria can spread throughout the body, causing arthritis, heart disease, and nervous system disorders such as facial paralysis."

To read the full article at the Bell's Palsy Information Site, please click here.

Last Updated- April 2019

Lucy Barnes