Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy)
Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell's palsy)
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DOI：
10.1186/1471-2334-11-215
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发表时间：
2011-08-10
影响因子：
3.7
通讯作者：
Hagberg, Lars
中科院分区：
文献类型：
--
作者：
Bremell, Daniel;Hagberg, Lars
背景：贝尔氏麻痹和莱姆氏神经疏松症是伯氏疏螺旋体流行地区周围性面瘫患者最常见的两种诊断。贝尔的瘫痪是用皮质类固醇治疗的，而莱姆神经疏松症是用抗生素治疗的。莱姆氏脑疏螺旋体病的诊断依赖于血液和/或脑脊液中疏螺旋体抗体的检测，这是一项耗时的工作。在这项研究中，我们回顾分析了由莱姆氏神经疏松症或贝尔麻痹引起的周围性面瘫患者的临床和脑脊液参数，以获得一个有效的诊断和急性期治疗决策的依据。方法：回顾Sahlgrenska大学医院感染科对腰椎穿刺术后周围性面瘫患者的住院记录。结果：共分析102例患者，其中贝尔麻痹51例，明确莱姆病34例，疑似莱姆病17例。明确患有莱姆氏神经疏螺旋体病的患者在下半年患病，高峰在8月份，而贝尔麻痹患者患病的方式在一年中更均匀地分布。确诊为莱姆氏疏松症的患者面部偏瘫区域外的神经系统症状明显增多，脑脊液中单核细胞和白蛋白水平显著升高。结论：在疏螺旋体流行地区，一年中的时间、相关的神经系统症状和单核细胞增多症是莱姆氏疏螺旋体病作为周围性面瘫原因的强烈预测因素。对于这些患者，我们建议早期口服多西环素辅助治疗比早期皮质类固醇治疗更可取。
Background: Bell's palsy and Lyme neuroborreliosis are the two most common diagnoses in patients with peripheral facial palsy in areas endemic for Borrelia burgdorferi. Bell's palsy is treated with corticosteroids, while Lyme neuroborreliosis is treated with antibiotics. The diagnosis of Lyme neuroborreliosis relies on the detection of Borrelia antibodies in blood and/or cerebrospinal fluid, which is time consuming. In this study, we retrospectively analysed clinical and cerebrospinal fluid parameters in well-characterised patient material with peripheral facial palsy caused by Lyme neuroborreliosis or Bell's palsy, in order to obtain a working diagnosis and basis for treatment decisions in the acute stage.Methods: Hospital records from the Department of Infectious Diseases, Sahlgrenska University Hospital, for patients with peripheral facial palsy that had undergone lumbar puncture, were reviewed. Patients were classified as Bell's palsy, definite Lyme neuroborreliosis, or possible Lyme neuroborreliosis, on the basis of the presence of Borrelia antibodies in serum and cerebrospinal fluid and preceding erythema migrans.Results: One hundred and two patients were analysed; 51 were classified as Bell's palsy, 34 as definite Lyme neuroborreliosis and 17 as possible Lyme neuroborreliosis. Patients with definite Lyme neuroborreliosis fell ill during the second half of the year, with a peak in August, whereas patients with Bell's palsy fell ill in a more evenly distributed manner over the year. Patients with definite Lyme neuroborreliosis had significantly more neurological symptoms outside the paretic area of the face and significantly higher levels of mononuclear cells and albumin in their cerebrospinal fluid. A reported history of tick bite was uncommon in both groups.Conclusions: We found that the time of the year, associated neurological symptoms and mononuclear pleocytosis were strong predictive factors for Lyme neuroborreliosis as a cause of peripheral facial palsy in an area endemic for Borrelia. For these patients, we suggest that ex juvantibus treatment with oral doxycycline should be preferred to early corticosteroid treatment.