Abstract Details

Title FACE DROP: A Clinical Risk Assessment Tool to Differentiate Acute Lyme Disease Facial Palsy From Bell’s Palsy

Topic Infectious Disease

Presentation(s) C4 - Models of Infection as a Trigger for Autoimmunity (2:28 PM-2:35 PM)
P2 - Poster Session 2 (2:45 PM-3:45 PM)

Poster/Presentation
Number 055

Background

Facial palsy is a common manifestation of Lyme disease, accounting for up to 5% of acute facial palsies in endemic regions. Lyme disease-associated facial palsy (LDFP) warrants prompt antibiotic therapy, while corticosteroid therapy is indicated for Bell’s palsy. The role of adjuvant corticosteroids in the treatment of acute LDFP is unclear. Current limitations of diagnostic laboratory tests for Lyme disease render acute differentiation of LDFP and BP challenging in many cases.

Objective

We aim to describe clinical features that differentiate Lyme disease associated facial palsy (LDFP) from Bell’s palsy (BP) at time of paralysis onset.

Design/Methods

We reviewed records from 287 patients with LDFP (N = 77) and BP (N = 210) referred to a specialized facial nerve center seen from 2005-2021 to determine clinical characteristics at time of presentation to medical care. We developed and internally validated a clinical risk assessment tool based on pertinent differences between signs and symptoms of LDFP and BP at presentation.

Results The risk assessment tool reliably distinguishes between LDFP and BP, with higher scores predicting LDFP and lower scores predicting BP, based on FACE DROP criteria: Fatigue (+3 points), Aches (arthralgia/myalgia; +5), Cephalgia (headache; +3), Elevated temperature (fever; +5), Dermatomal manifestations (transverse myelitis/radiculitis; +3), Rigidity of neck (nuchal rigidity; +2), and Otalgia/Postauricular pain (-1). The score provides an accurate prediction of LDFP versus BP with increasing ability to discriminate with higher scores. Using a cutoff score of 5 or greater to define LDFP, FACE DROP predicted LDFP with 96.2% sensitivity and 81.3% specificity.

Conclusions A novel risk assessment tool to distinguish LDFP from BP was developed. This tool may help guide the prescribing of antimicrobials targeted to Lyme in the setting of acute facial palsy even in the absence of erythema migrans rash and before confirmatory laboratory evidence is available.

Authors/Disclosures
Caleb R. McEntire, MD (MGH-Brigham Neurology) PRESENTER	Dr. McEntire has nothing to disclose.
Sun Young Chung	Ms. Chung has nothing to disclose.
Brian Chang, MD, PhD	Dr. Chang has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for MicroPort. Dr. Chang has received intellectual property interests from a discovery or technology relating to health care.
Keisha Barrera	Ms. Barrera has nothing to disclose.
Yan Zhao (Massachusetts Eye and Ear)	No disclosure on file
Gary Wormser (New York Medical College)	No disclosure on file
Nathan Jowett	No disclosure on file
Bart Chwalisz, MD (Massachusetts General Hospital, Department of Neurology)	Dr. Chwalisz has nothing to disclose.