Can Lyme Disease Cause Bell’s Palsy?
Yes—Lyme disease can cause Bell’s palsy.
Facial droop may be an early neurologic sign.
Steroids may worsen outcomes if Lyme is missed.
Yes. Lyme disease can cause Bell’s palsy. It is one of the most common neurologic symptoms of Lyme disease and may be an early sign of infection.
Lyme-related Bell’s palsy occurs when the infection affects the facial nerve, leading to weakness or drooping on one side of the face.
This condition involves the facial nerve (cranial nerve VII), which is why some clinicians refer to it as a 7th nerve palsy or facial nerve palsy.
Patients often search for “can Lyme disease cause Bell’s palsy” when facial weakness appears suddenly without a clear cause.
In Lyme-endemic areas, Bell’s palsy should always prompt consideration of Lyme disease.
How Common Is Bell’s Palsy in Lyme Disease?
There are varying presentations of Lyme disease, with erythema migrans and arthritis being the most commonly recognized symptoms.
However, neurologic symptoms are also important. According to a case review published in the Canada Communicable Disease Report, Bell’s palsy has been reported in 8.2% of Lyme disease cases in Canada.
This means Bell’s palsy is not rare—and should raise suspicion for Lyme disease in endemic areas.
What Does Lyme Disease Bell’s Palsy Feel Like?
Patients may notice facial droop, difficulty closing one eye, or asymmetry of the face.
- Sudden weakness on one side of the face
- Difficulty closing the eye
- Drooping of the mouth
- Changes in facial expression
These symptoms may appear abruptly and can be mistaken for idiopathic Bell’s palsy.
Case Example: Bell’s Palsy from Lyme Disease
The following case illustrates how Lyme disease can present as Bell’s palsy:
A healthy 46-year-old man was admitted to the emergency room with left facial drooping and an inability to completely close his left eyelid.
He also had multiple red blotchy lesions consistent with erythema migrans and reported frequent hiking in endemic regions.
Clinicians diagnosed early disseminated Lyme disease presenting as Bell’s palsy and started doxycycline immediately without waiting for test results.
Early treatment is critical and should not be delayed for laboratory confirmation.
Why Lyme Disease Bell’s Palsy Can Be Missed
Bell’s palsy is often treated as idiopathic. However, in Lyme-endemic regions, infection should be considered.
Failure to recognize Lyme disease can lead to inappropriate treatment and worse outcomes.
Steroids and Lyme Disease Bell’s Palsy
Steroids may worsen outcomes in Lyme disease Bell’s palsy. This is why distinguishing Lyme-related facial palsy from idiopathic Bell’s palsy is critical.
Idiopathic Bell’s palsy is often treated with corticosteroids. However, in Lyme disease, this approach may be harmful.
A study found worse long-term outcomes associated with corticosteroid use in Lyme disease facial palsy.
This highlights the importance of identifying Lyme disease before starting steroids.
Diagnosis and Treatment
For this patient, clinicians:
- Started doxycycline immediately
- Ordered confirmatory testing
- Extended treatment to 21 days
- Scheduled follow-up monitoring
Most Lyme-related Bell’s palsy improves with appropriate antibiotic treatment.
Does Bell’s Palsy from Lyme Disease Go Away?
In many cases, facial nerve function improves with treatment.
However, outcomes vary. Some patients may experience persistent symptoms or incomplete recovery.
Early recognition and treatment improve the likelihood of recovery.
Clinical Takeaway
Lyme disease is an important and often overlooked cause of Bell’s palsy.
When facial weakness appears suddenly—especially in endemic areas—the underlying cause should be carefully evaluated.
Recognizing Lyme disease early can prevent misdiagnosis, avoid inappropriate steroid use, and improve outcomes.
Frequently Asked Questions
Can Lyme disease cause Bell’s palsy?
Yes. Lyme disease can affect the facial nerve and cause Bell’s palsy.
Should Lyme disease be tested in Bell’s palsy?
Yes. Testing should be considered, especially in endemic areas or when other symptoms are present.
Do steroids help Lyme-related Bell’s palsy?
Not always. Steroids may worsen outcomes if Lyme disease is the cause.
Does Lyme Bell’s palsy go away?
Many patients improve with treatment, but recovery can vary.
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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
An incident of Bell’s palsy and slurred speech along with a visit to a Lyme literate doctor in the same week changed the course of my life and health. I didn’t choose the Lyme literate doctor but was the driver of a Lyme patient which gave me an “unofficial” visit with the doctor who found my illness that had little by little impacted my life for 13 plus years.