LP for any child with facial palsy & possible LB?

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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LP for any child with facial palsy & possible LB?

Post by RitaA » Thu 7 Feb 2013 7:43

Arch Pediatr. 2012 Dec;19(12):1354-61. doi: 10.1016/j.arcped.2012.09.016. Epub 2012 Oct 30.

[Should a lumbar puncture be performed in any child with acute peripheral facial palsy and clinical suspicion of Lyme borreliosis?].

[Article in French]

Blin-Rochemaure N, Quinet B.


Service de neuropédiatrie, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France.


Lyme borreliosis should be considered in any child affected with acute peripheral facial palsy without obvious cause in endemic areas, especially if it happens from May to November, with a history of erythema migrans, tick bite, or possible exposure during the previous weeks. The clinical appearance of Lyme borreliosis differs between adults and children and according to the geographical origin of the infection: therefore it is difficult to interpret and follow the recommendations for the management and treatment of this disease. Neuroborreliosis is more frequent in Europe than in the United States, and meningitis associated to facial palsy occurs earlier and is more frequent among the European pediatric population, too. When peripheral facial palsy occurs and there is suspicion of Lyme borreliosis, it seems necessary to perform a lumbar puncture in order to support the diagnosis with detection of intrathecal synthesis of specific antibodies, sometimes more abundant than in the serum, and thus to adapt the antibiotic therapy modalities. Parenteral antibiotherapy is recommended if any involvement is detected in the cerebrospinal fluid, while oral antibiotherapy should be prescribed for isolated facial palsies. Follow-up should be made according to clinical symptoms with a close collaboration between pediatricians, infection disease specialists, and ENT specialists.

Copyright © 2012 Elsevier Masson SAS. All rights reserved.

PMID: 23116983 [PubMed - in process]

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Re: LP for any child with facial palsy & possible LB?

Post by RitaA » Wed 22 Jan 2014 19:54

The answer appears to be "yes" when it comes to whether or not a lumbar puncture should be performed in children with facial palsy -- especially in areas where Lyme disease is known to exist.

Although a borrelia infection may be the most frequent cause of acute facial palsy in children (at least in this study), it is by no means the only type of infection that may result in facial palsy:

Otol Neurotol. 2013 Sep;34(7):e82-7. doi: 10.1097/MAO.0b013e318289844c.

Microbiologic findings in acute facial palsy in children.

Kanerva M, Nissinen J, Moilanen K, Mäki M, Lahdenne P, Pitkäranta A.

Author information

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland



Microbiologic causes of facial palsy in children were investigated.


Prospective clinical study.


Tertiary referral center.


Forty-six children aged 0 to 16 years with peripheral facial palsy.


Paired serum samples and cerebrospinal fluid were tested to find indications of microbes associated with facial palsy. The microbes tested were herpes simplex virus 1 and 2, varicella-zoster virus, human herpesvirus-6, Mycoplasma pneumoniae, Borrelia burgdorferi, influenza A and B virus, picorna, cytomegalovirus, parainfluenza virus, respiratory syncytial virus, coxsackie B5 virus, adenovirus, and enterovirus, Chlamydia psittaci, and Toxoplasma gondii. Besides the routine tests in clinical practice, serum and cerebrospinal fluid samples were tested with a highly sensitive microarray assay for DNA of herpes simplex virus 1 and 2; human herpes virus 6A, 6B, and 7; Epstein-Barr virus, cytomegalovirus, and varicella zoster virus.


Incidence for facial palsy was 8.6/100,000/children/year. Cause was highly plausible in 67% and probable in an additional 11% of cases. Borrelia burgdorferi caused facial palsy in 14 patients (30%), varicella zoster virus in 5 (11%) (one with concomitant adenovirus), influenza A in 3 (6%), herpes simplex virus 1 in 2 (4%) (one with concomitant enterovirus), otitis media in 2 (4%), and human herpesvirus 6 in 2 (4%). Mycoplasma pneumoniae, neurofibromatosis, and neonatal age facial palsy affected 1 child (2%) each.


Microbiologic etiology association of pediatric facial palsy could frequently be confirmed. Borreliosis was the single most common cause; hence, cerebrospinal fluid sampling is recommended for all pediatric cases in endemic areas. Varicella zoster virus accounted for 11% of the cases, being the second most common factor.

[PubMed - in process]

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Re: LP for any child with facial palsy & possible LB?

Post by inmacdonald » Thu 23 Jan 2014 18:18

Facial nerve palsies - unilateral bilateral evanescent or persistent types

4 types of VII nerve palsy associated with some cases of borreliosis(lyme) are now in the
medical literature.

simultaneous onset of BLIATERAL Facial palsy : is associated with a very limited differential Diagnosis:
1.Hopefully ------ -due to borrelia infection
2. Unfortunately - some due to Brain stem tumors

Sampling of CSF is problematic in cases of Rule Out Brain Stem Tumors- due to possible risk of
Brain cerebellar tonsil herniation as a result of the Lumbar puncture.
Here, An MRI scan prior to L.P might be the best plan
Central VII palsy versus Peripheral VII deficits can be sorted out by the Neurology consultant

ASSUMPTION UNREASONABLE: " Everyone knows that Lyme VII Palsies are ALWAYS reversible; False!!!!!

Prompt and appropriate Treatment for spirochetal infection induced VII cranial nerve palsies -
Always the Best Plan for management.

Alan B. MacDonald MD, FCAP., FASCP
Jan 23,2014

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Re: LP for any child with facial palsy & possible LB?

Post by RitaA » Thu 14 May 2015 2:29

Possible causes of bilateral facial palsy (i.e. facial muscle weakness) are listed and briefly described here:

http://www.ncbi.nlm.nih.gov/pmc/article ... 000989TB1/
Table 1

The differential diagnosis of acute bifacial weakness

Causes and Comments

Guillain–Barré syndrome: Presents with a variety of associated features. Acute inflammatory demyelinating polyradiculoneuropathy is the most common subtype to show cranial nerve involvement and pharyngeal–cervical–brachial weakness and Miller Fisher syndrome often have facial weakness.

Brainstem lesions and malignancy: Lesions at the level of the pontine tegmentum can affect both facial motor nuclei. These may be meningeal or parenchyma based.

Lyme disease: Acute infection may present as Bannwarth syndrome with meningitis, radiculoneuritis and cranial nerve palsies. The facial nerve is most frequently affected, and half of the cases have bilateral facial nerve palsy.

Syphilis: Syphilis displays protean disease manifestations and has the potential to produce cranial neuropathy, including facial nerve palsy, during the tertiary stage of disease with syphilitic meningitis.

Tuberculosis: Tuberculous meningitis may produce cranial nerve palsies.

Sarcoidosis: Cranial nerve neuropathy, particularly of the facial nerve, is the most common complication of neurosarcoidosis. Bifacial palsy may develop simultaneously or in sequence.

Sjögren's syndrome: Rare but documented association in the literature

Bell's palsy: Bilateral Bell's palsy is the most common cause of facial diplegia. It commonly presents with pain around the ear, hyperacusis, loss of taste and lacrimation. However, it should remain as a diagnosis of exclusion.

‘Facial-onset sensorimotor neuropathy’: A novel neurological entity, initially presents with facial sensory deficits, with a slow evolution in a rostral–caudal direction to affect sequentially the neck, upper trunk and limbs.

Neuromuscular disorders: Botulism or myasthenia gravis commonly present with bifacial weakness.

Acute myopathies: Polymyositis rarely causes bifacial weakness.

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