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High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region

High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region
High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region
Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease.

Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st 2010 and December 31st 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management.

Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%.

Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.
Bells palsy, Facial nerve palsy, Lyme disease
0165-5876
Munro, Alasdair
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Dorey, Robert B.
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Owens, Daniel
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Steed, Duncan
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Petridou, Christina
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Herdman, Trent
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Jones, Christine E
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Patel, Sanjay
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Pryde, Kate
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Faust, Saul
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Munro, Alasdair
59dacf7d-5977-49c4-b562-b2c719c9dcf4
Dorey, Robert B.
8d4b042f-1659-4e76-99c2-23cde78ca4f5
Owens, Daniel
3a66adc3-6a24-4eca-a171-1880a8372fe6
Steed, Duncan
8c5d241c-6adc-4bc8-8d06-b26311277e46
Petridou, Christina
dc8dfd9a-60f5-42dc-86b2-e98b1c7a277a
Herdman, Trent
4cb10ee2-3771-4096-9040-30ca91f01e0c
Jones, Christine E
48229079-8b58-4dcb-8374-d9481fe7b426
Patel, Sanjay
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Pryde, Kate
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Faust, Saul
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Munro, Alasdair, Dorey, Robert B., Owens, Daniel, Steed, Duncan, Petridou, Christina, Herdman, Trent, Jones, Christine E, Patel, Sanjay, Pryde, Kate and Faust, Saul (2020) High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region. International Journal of Pediatric Otorhinolaryngology, 132, [109905]. (doi:10.1016/j.ijporl.2020.109905).

Record type: Article

Abstract

Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease.

Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st 2010 and December 31st 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management.

Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%.

Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.

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IJPORL_D_19_00803R2 - Accepted Manuscript
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Accepted/In Press date: 22 January 2020
e-pub ahead of print date: 25 January 2020
Keywords: Bells palsy, Facial nerve palsy, Lyme disease

Identifiers

Local EPrints ID: 437485
URI: http://eprints.soton.ac.uk/id/eprint/437485
ISSN: 0165-5876
PURE UUID: 075dd54a-7739-490a-b2a1-8bc8be9204eb
ORCID for Christine E Jones: ORCID iD orcid.org/0000-0003-1523-2368
ORCID for Saul Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 31 Jan 2020 17:34
Last modified: 26 Nov 2021 05:36

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Contributors

Author: Alasdair Munro
Author: Robert B. Dorey
Author: Daniel Owens
Author: Duncan Steed
Author: Christina Petridou
Author: Trent Herdman
Author: Sanjay Patel
Author: Kate Pryde
Author: Saul Faust ORCID iD

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