Canadian Lyme Disease Foundation Bulletin Board

[lou2]

CJEM 2012; 14: 1-4.

Bell palsy in Lyme disease-endemic regions of Canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease.

Ho K, Melanson M, Desai JA

The spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy.

In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.

http://www.ncbi.nlm.nih.gov/pubmed/22480492

[journerr]

Hi Everyone;
I'm hoping someone could clarify the following quote from this article:

facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis.

My confusion is the reference to serological testing (in Canadian endemic areas) to avoid misdiagnosis.
Could anyone elaborate ? What test exactly is being referred to ? ...... & the point of my confusion; if there is a test available in Canada that avoids misdiagnois, maybe we should all develop facial palsy ????

[lou2]

I assumed when it described this as "occult," it meant that lyme was not suspected initially, and that other cases of facial palsy might also be lyme and therefore should be considered as a possible diagnosis.

Also, it appeared that they were saying treatment should not be withheld pending blood testing, but I am less sure about that interpretation. They may be assuming that serological results are accurate always, when we know they are not.

[RitaA]

Hi folks,

I could be wrong, but I do believe the authors of the article are recommending that patients who live in Lyme disease endemic areas be tested for Lyme disease using the standard 2-tier testing method. This is problematic for a few reasons -- including the fact that even those people who might eventually test positive may not do so for many weeks. In the meantime, the standard treatment for Bell Palsy is corticosteroids -- something that should be avoided in anyone with an infection because they suppress a person's immune system.

http://emedicine.medscape.com/article/1146903-overview

[lou2]

Thank you, Rita. They would certainly be recommending the two step process, and I was with them until they got to the last sentence. Treat before you know what the cause is?

Had heard that many different things could cause Bell's palsy, but that list you posted was surprisingly long.

It is true that steroids are bad for people with infectious diseases, however I have heard of lyme patients getting steroids in conjunction with antibiotics in certain specific cases. What you wouldn't want is unopposed steroids in an unsuspected lyme case, or an uneducated doctor trying to treat this if it was lyme disease. Since the testing is fallible, that uneducated doctor is going to think that a negative result couldn't be a false negative.

[RitaA]

Hi lou,

Yes, I agree that unopposed corticosteroids would pose a much greater risk than combining them with antibiotics. My husband was treated many times in the past with both steroids and antibiotics for chest infections that made breathing very nearly impossible for him, so I do believe there are times when prescribing both is good medical judgment.

There is so much to consider when tick-borne illnesses are concerned that having a knowledgeable healthcare provider is definitely the way to go. Unfortunately, there are many Canadians (and no doubt people in other countries) who simply can't afford this "luxury". While I've seen some definite progress in the past year, we still have a long way to go when it comes to public education and that of medical professionals. It may seem like baby steps at times, but at least we're headed in the right direction.

Isn't it funny (as in ironic) how the "gold standard" 2-tier testing is considered virtually foolproof and reliable by so many, even while quite a few "experts" are now trying to scrap the IgM Western Blot test altogether because it's considered so unreliable? Something isn't adding up in my mind, but I don't fully understand the reasons for this and so much more when it comes to Lyme disease.