Facial nerve dysfunction after treatment for Lyme disease


Some individuals with Facial Nerve Palsy (Bell’s palsy) have reportedly had facial nerve dysfunction, as long as one year after antibiotic treatment for Lyme disease. Some suffer from synkinesis, where patients present with unwanted contractions of the muscles of the face during attempted movement. They may notice forceful eye closure when they attempt to smile or other muscle spasms during routine facial movements.

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.¹

  • 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 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.²

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.”³

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.4

“We recommend screening patients with APFP for associated and treatable factors, especially Lyme disease in regions where the disease is endemic.”4

  1. 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. Aug 2018;91(4):336-338. doi:10.1016/j.diagmicrobio.2018.03.016
  2. Shokri T, Azizzadeh B, Ducic Y. Modern Management of Facial Nerve Disorders. Semin Plast Surg. Nov 2020;34(4):277-285. doi:10.1055/s-0040-1721824
  3. LeWitt TM. Hemifacial Spasm From Lyme Disease: Antibiotic Treatment Points to the Cause. Clin Neuropharmacol. Nov/Dec 2016;39(6):329-330. doi:10.1097/WNF.0000000000000193
  4. Ramsey DJ, Haas LP, Tucker SM. Long-term Outcome After Acute Peripheral Facial Palsy. Ophthalmic Plast Reconstr Surg. Jan 27 2022;doi:10.1097/IOP.0000000000002134

7 Replies to "Facial nerve dysfunction after treatment for Lyme disease"

  • Paul Bortz
    06/27/2022 (3:21 pm)

    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.

  • J
    06/27/2022 (10:22 am)

    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,


    • Dr. Daniel Cameron
      06/27/2022 (8:14 pm)

      I often have patients in my practice where one side is more affected than the other.

  • Melinda
    06/27/2022 (10:17 am)

    I’ve seen where some doctors believe this could be helped by botox. What say you ?

    • Dr. Daniel Cameron
      06/27/2022 (8:13 pm)

      I am sorry I do not have enough information to help you.

    • Marcie
      06/30/2022 (3:02 pm)

      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.

      • Dr. Daniel Cameron
        07/01/2022 (6:58 am)

        I have few patients in my practice with facial nerve dysfunction. Thanks for sharing.

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