Lyme Disease Overview (with focus on Facial Palsy)

Facial Palsy occurs during the “Early Disseminated” Stage of Lyme

STAGES OF LYME DISEASE — from time of tick exposure

Early Localized (1-4 wks)
  • Erythema Migrans (EM) lesion(s)  [see pix below]
  • Generalized arthralgias, myalgias, fatigue, malaise, “viral syndrome”
Early Disseminated Disease (few wks to several months)
  • Migratory Arthralgias
  • Multiple EM lesions
  • Meningeal Sx
  • Cranial Nerve Palsies (esp. facial nerve)
  • Radiculopathy / Peripheral neuropathy
  • Cerebellar Ataxia
  • Carditis (A-V Block, often asymptomatic)
Late (months to years)
  • Mono- / Oligo-arthritis
  • Neuro:  Subtle cognitive deficits, paresthesias, radiculopathy (not CN7 Palsy)


Vast Majority of cases: VA (northern tip), MD, DL, NJ, PA, NY (eastern), New England, Wisc, Minn.
  • Forested areas
  • Also suburbs of Boston, NYC, Phila
Tick Season:  mid-May to late-July
  • Most pts don’t notice tiny nymph ticks
  • CN7 Palsy occurs weeks to months after bite

DIAGNOSIS  —  Antibodies to Borrelia burgdorferi (ELISA / IFA; Western Blot)

Early Localized  —  EM lesion(s)
  • Serology negative
Early Disseminated  —  ELISA / IFA
  • If negative = No Lyme Disease
  • If positive: confirm with Western Blot IgM and IgG
    • IgM is diagnostic
Late  —  ELISA / IFA
  • If negative = No Lyme Disease
  • If positive: confirm with Western Blot IgG
Note  —  Many residents of endemic areas are seropositive from prior asymptomatic infection
  • Serology only useful for specific clinical symptoms
  • EM lesions (rash is diagnostic: just Tx)
  • Arthralgias / myalgias without other symptoms of Early Disseminated Disease
  • Screen asymptomatic people
Erythema Migrans (EM)  (Multiple Lesions in ~20% of Pts)
  • Note that early lesions may be small & subtle



Multiple EM Lesions [approx. 20% or pts]