Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes

Laryngoscope. 2017 Jun;127(6):1451-1458. doi: 10.1002/lary.26273. Epub 2016 Sep 6.


Objective: The purpose of this study was to determine whether differences in long-term facial function outcomes following acute Lyme disease-associated facial palsy (LDFP) exist between patients who received antibiotic monotherapy (MT); dual therapy (DT) with antibiotics and corticosteroids; and triple therapy (TT) with antibiotics, corticosteroids, and antivirals.

Study design: Retrospective cohort.

Methods: All patients with a prior diagnosis of unilateral LDFP who presented to our center between 2002 and 2015 were retrospectively assessed for inclusion. Two blinded experts graded static, dynamic, and synkinesis parameters of facial functions using standardized video documentation of facial function.

Results: Fifty-one patients were included. The mean time of assessment following LDFP onset was 15.1 months (range 0.3-84 months). Significantly worse facial outcomes were seen among those who received DT and TT as compared to those who received MT, most pronounced among those assessed 12 months or later following onset of LDFP (Dynamic-P = 0.031, post hoc MT vs. TT: mean difference [MD], 15.83; 95% confidence interval [CI], 1.54-30.13; P = 0.030. Synkinesis-P = 0.026, post hoc MT vs. DT: MD, 21.50; 95% CI, 0.68-42.32; P = 0.043, post hoc MT vs. TT: MD, 19.22; 95% CI, 2.23-36.22; P = 0.027).

Conclusion: An association between corticosteroid use in acute LDFP and worse long-term facial function outcomes has been demonstrated. Care should be taken in differentiating viral or idiopathic facial palsy (e.g., Bell palsy) from LDFP.

Level of evidence: 4. Laryngoscope, 127:1451-1458, 2017.

Keywords: Borrelia burgdorferi; Corticosteroids; Lyme disease; facial nerve; facial palsy; facial paralysis; facial spasm; glucocorticoids; nerve regeneration; neuroborreliosis; outcomes; prednisone; synkinesis.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage*
  • Antiviral Agents / administration & dosage*
  • Child
  • Drug Therapy, Combination / adverse effects
  • Facial Paralysis / drug therapy*
  • Facial Paralysis / etiology
  • Facial Paralysis / physiopathology
  • Female
  • Humans
  • Lyme Disease / complications
  • Lyme Disease / drug therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Time
  • Treatment Outcome
  • Young Adult


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antiviral Agents