High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region

Alasdair P.S. Munro*, Robert B. Dorey, Daniel R. Owens, Duncan J. Steed, Christina Petridou, Trent Herdman, Christine E. Jones, Sanjay V. Patel, Kate Pryde, Saul N. Faust

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease. Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st, 2010 and December 31st, 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management. Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6–12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.

Original languageEnglish
Article number109905
JournalInternational Journal of Pediatric Otorhinolaryngology
Publication statusPublished - May 2020

Bibliographical note

Publisher Copyright:
© 2020 Elsevier B.V.


  • Bells palsy
  • Facial nerve palsy
  • Lyme disease


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