How to Distinguish Lyme-Associated Facial Palsy from Bell Palsy

Bell palsy is the most frequent form of acute facial paralysis worldwide, whereas acute facial palsy occurs in up to 5% of patients with acute Lyme disease. Although their clinical presentation may be similar, Lyme disease–associated facial palsy (LDFP) differs in important ways and may have additional symptoms such as erythema migrans and neurologic manifestations (e.g., meningitis, transverse myelitis, or radiculitis). To create a clinical tool to distinguish these two conditions, the authors reviewed records from 285 patients with facial palsy seen at a tertiary care center from 2005 to 2021, of whom 76 had LDFP and 209 had Bell palsy.

The authors developed the tool, FACE DROPS, based on 7 clinical differences in signs and symptoms betwee…