Facial Nerve Dysfunction After Lyme Disease Treatment

In their study, Wormser and colleagues found that 6 of the 11 Lyme disease patients (54.5%) suffered from facial nerve dysfunction an average of 13.1 months following the onset of treatment with corticosteroids.

Patient Cases: Long-Term Complications

The patients who continued to have facial nerve dysfunction included:

• 52-year-old man with “tearing of left eye when eating (Bogorad’s syndrome); mild residual weakness left side”
• 51-year-old man with “mild residual left sided weakness; dryness left eye; after speaking a lot, left sided facial muscles feel abnormal”
• 56-year-old man with “narrowed palpebral fissure right eye; dry mouth; sensation of muscles around right eye being squeezed; tearing of right eye; twitching of the area between the eyes on the forehead; new dimple right cheek; intermittent lisp”
• 25-year-old man with “narrowed palpebral fissure left eye; reduced forehead movement; right sided jaw discomfort with eating; tearing of the left eye when eating (Bogorad’s syndrome)”
• 61-year-old man with “narrowed palpebral fissure right eye; difficulty whistling; right eye discharge at night”
• 70-year-old woman who had “surgical facial nerve decompression nearly 3 months after onset of the LDFP (Lyme disease facial palsy)”

Understanding Facial Synkinesis and Related Complications

“Facial synkinesis presents following injury to the facial nerve and manifests as involuntary movement during volitional or spontaneous movement. This phenomenon may become clinically apparent 3 to 4 months following facial nerve injury,” wrote Shokri et al.

Additionally, LeWitt described a case of hemifacial spasm (HFS) from Lyme disease and concluded that “Because its diagnosis can be occult and antibiotic therapy can be both diagnostic and therapeutic, Lyme disease should be a consideration for cases of HFS.”

Screening Recommendations in Endemic Areas

Ramsey and colleagues examined acute peripheral facial palsy (APFP) in Lyme disease patients and found that “10% of patients with APFP testing positive for Lyme disease may be an underestimate, since several other studies in endemic areas have reported rates varying from 14.7% to 33%.”

The authors did not indicate how many of their patients had incomplete eyelid closure or abnormal facial movement from aberrant regeneration. “We recommend screening patients with APFP for associated and treatable factors, especially Lyme disease in regions where the disease is endemic.”

Frequently Asked Questions

Can facial nerve dysfunction persist after Lyme disease treatment?

Yes. Studies show that 54.5% of patients treated with corticosteroids developed facial nerve dysfunction lasting an average of 13.1 months after treatment began. Some complications can persist even longer, affecting daily activities and quality of life.

What is facial synkinesis?

Facial synkinesis is involuntary facial movement that occurs when trying to make a different expression. For example, the eye may close when trying to smile, or the mouth may move when blinking. It typically becomes apparent 3 to 4 months after facial nerve injury.

What percentage of facial palsy cases are caused by Lyme disease?

Studies in endemic areas report that 10% to 33% of acute peripheral facial palsy cases test positive for Lyme disease. The actual percentage may be higher, as some cases go undiagnosed or untested.

Should all patients with facial palsy be tested for Lyme disease?

Yes, particularly in endemic regions. Experts recommend screening all patients with acute peripheral facial palsy for Lyme disease, as early identification and appropriate antibiotic treatment can prevent long-term complications.

What is hemifacial spasm and can Lyme disease cause it?

Hemifacial spasm (HFS) is involuntary twitching or contracting of muscles on one side of the face. Lyme disease should be considered as a potential cause of HFS, especially when the diagnosis is unclear, as antibiotic therapy can be both diagnostic and therapeutic.

Clinical Takeaway

This study reveals a sobering pattern: more than half of Lyme disease patients treated with corticosteroids developed persistent facial nerve dysfunction lasting over a year. These complications—synkinesis, Bogorad’s syndrome, hemifacial spasm—are not minor inconveniences. They affect facial expression, eating, social interaction, and quality of life. Some patients required surgical intervention.

The critical message for clinicians: in endemic areas, screen all acute facial palsy patients for Lyme disease before reaching for steroids. Early antibiotic treatment may prevent the long-term complications documented in this study. For patients who develop persistent facial nerve dysfunction after treatment, recognize that this is a known complication requiring specialized management and continued support.