Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States.
Characteristics and outcome of facial nerve palsy from Lyme neuroborreliosis in the United States.
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DOI：
10.1002/acn3.51488
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发表时间：
2022-01
影响因子：
5.3
通讯作者：
Ortega-Villa AM
中科院分区：
文献类型：
--
作者：
Marques A;Okpali G;Liepshutz K;Ortega-Villa AM
面神经麻痹是美国莱姆病神经疏螺旋体病（LNB）最常见的表现。本研究的目的是描述早期LNB患者表现为面神经麻痹的特征，并确定除抗生素治疗外，皮质类固醇是否与不良结局相关。对参加莱姆病临床研究的参与者（N = 486）进行回顾性分析，确定了44例因LNB而发生面瘫的患者。House-Brackmann量表用于量化面神经功能障碍。大多数患者在夏季就诊。29例患者发生游走性红斑，常伴有全身症状。13例患者表现为双侧面瘫，通常伴有顺序性受累。14例患者有疼痛性神经根病。在38名在麻痹消退前接受抗生素治疗的患者中，有24名患者接受了抗生素和皮质类固醇治疗。在这38例患者中，34例完全恢复，3例几乎完全恢复，1例中度功能障碍。两个治疗组在12个月时麻痹完全消退或完全恢复时间方面没有差异。在麻痹前几周内，皮疹病史与游走性红斑或发热性疾病相一致，是指向LNB的有用线索，在评估急性发作的周围性面瘫患者时，应积极寻找，特别是双侧面瘫。抗生素治疗是非常有效的，大多数患者将完全恢复面神经功能。在这项回顾性观察性研究中，皮质类固醇辅助治疗似乎不影响恢复速度或总体结局。
Facial palsy is the most common manifestation of Lyme neuroborreliosis (LNB) in the United States. This study aimed to describe features of patients with early LNB presenting with facial palsy and to determine if corticosteroids in addition to antibiotic therapy was associated with unfavorable outcome. Retrospective analysis of participants enrolled in clinical studies investigating Lyme disease (N = 486) identified 44 patients who had facial palsy from LNB. The House–Brackmann scale was used to quantify the facial nerve dysfunction. Most patients presented in the summer months. Erythema migrans, frequently associated with systemic symptoms, occurred in 29 patients. Thirteen patients presented with bilateral facial palsy, usually with sequential involvement. Fourteen patients had painful radiculopathy. Of the 38 patients treated with antibiotics before the resolution of the palsy who had complete follow‐up, 24 received both antibiotics and corticosteroids. Of these 38 patients, 34 recovered completely, 3 had nearly complete recovery, and 1 had moderate dysfunction. There were no differences between the treatment groups in achieving complete resolution of the palsy at 12 months or in time to complete recovery. A history of rash compatible with erythema migrans or febrile illness in the weeks preceding the palsy are helpful clues pointing toward LNB and should be actively sought when evaluating patients with acute‐onset peripheral facial palsy, particularly bilateral facial palsy. Treatment with antibiotic therapy is highly effective and most patients will fully recover facial nerve function. Adjunctive corticosteroid therapy appears to not affect the speed of recovery or overall outcome in this retrospective observational study.
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