Facial Nerve Dysfunction After Lyme Disease Treatment
Facial nerve dysfunction after Lyme disease treatment can persist for months and may significantly affect quality of life. In their study, Wormser and colleagues found that 6 of 11 Lyme disease patients (54.5%) experienced ongoing facial nerve dysfunction an average of 13.1 months after treatment began with corticosteroids.
Patient Cases: Long-Term Facial Nerve 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)”
Facial Synkinesis and Other Complications After Lyme Disease
Facial synkinesis can develop after injury to the facial nerve and may complicate recovery in patients with Lyme disease facial palsy.
“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) due to 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.”
Why Lyme Disease Should Be Considered in Facial Palsy
Ramsey and colleagues examined acute peripheral facial palsy (APFP) 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 due to aberrant regeneration. However, they concluded: “We recommend screening patients with APFP for associated and treatable factors, especially Lyme disease in regions where the disease is endemic.”
These findings support the need for careful evaluation of Lyme disease symptoms in any patient presenting with facial palsy in endemic regions.
Frequently Asked Questions About Facial Nerve Dysfunction in Lyme Disease
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 and affect 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 may be due to 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 because some cases are not recognized or tested.
Should all patients with facial palsy be tested for Lyme disease?
In endemic regions, Lyme disease should be strongly considered in all patients with acute peripheral facial palsy. Early diagnosis and antibiotic treatment may help reduce the risk of long-term complications.
Can Lyme disease cause hemifacial spasm?
Yes. Hemifacial spasm is involuntary twitching or contraction of muscles on one side of the face. Lyme disease should be considered as a potential cause, especially when the diagnosis is unclear.
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—including synkinesis, Bogorad’s syndrome, hemifacial spasm, dryness, tearing, and residual weakness—are not minor inconveniences. They can affect facial expression, eating, speaking, eye comfort, social interaction, and quality of life.
The clinical message is clear: in endemic areas, screen patients with acute facial palsy for Lyme disease before assuming idiopathic Bell’s palsy or prescribing corticosteroids. Early recognition and appropriate antibiotic treatment may help reduce the long-term complications documented in this study.
Related Reading
References
- Wormser GP, McKenna D, Scavarda C, Karmen C. Outcome of facial palsy from Lyme disease in prospectively followed patients who had received corticosteroids. Diagn Microbiol Infect Dis. 2018;91(4):336-338.
- Shokri T, Azizzadeh B, Ducic Y. Modern Management of Facial Nerve Disorders. Semin Plast Surg. 2020;34(4):277-285.
- LeWitt TM. Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause. Clin Neuropharmacol. 2016;39(6):329-330.
- Ramsey DJ, Haas LP, Tucker SM. Long-term Outcome After Acute Peripheral Facial Palsy. Ophthalmic Plast Reconstr Surg. 2022;38(4):376-381.
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
I’ve seen where some doctors believe this could be helped by botox. What say you ?
I had Bell’s palsy, and tongue and jaw spasms, along with burning mouth, tooth, and gum pain. I finally realized I have trigeminal neuralgia. This is about 3 years after getting bitten by a black-legged deer tick, and contracting Lyme disease.
Welcome to the club. I dont know why the left side is more effected then the right, maybe because it’s the weaker side.
We need a cure!
I have tearing in my left biceps, pain in shoulder up to my neck, feels like radiculopathy, left cheek feels like it has cobwebs over it and occasional itchy eyes and itchy feet. The most recent symptom is De Quervains, a very painful condition that effect the thumb of either both hands, also more effected on the left side.
I wish someone could make sense of what it particular this disease is targeting so I can centralize the pain management process. Is it the nerves, the tendons, the root nerves, peripheral, small fiber nerves,
HEEELP!
Have facial nerve damage on face after 9 years of Lyme disease. Have gone to John Hopkins to Dr. Alcott and still live with this terrible desease.