Lyme Disease and Facial Weakness: What You Should Know

Did you know that a tick bite can sometimes cause facial paralysis? Dr. Nate Jowett of the Facial Nerve Center at Mass. Eye and Ear breaks down Lyme disease associated-facial palsy — and what you need to know to make sure you get the right treatment.

Ticks are those small, pesky bugs known for carrying Lyme disease, a bacterial infection transmitted through the bite of an infected tick. The CDC estimates that blacklegged ticks, or “deer ticks,” infect more than 300,000 Americans with Lyme disease each year.

“Lyme disease is prevalent in New England, and it can be challenging to diagnose,” said Nate Jowett, MD, a specialist in the Facial Nerve Center at Mass. Eye and Ear. “It’s important for those at risk to know the potential symptoms — especially those who venture into wooded or grassy areas.”

Signs of Lyme Disease

Lyme disease symptoms may begin anywhere from days to weeks following exposure and often vary greatly between individuals. Many patients do not even recall being bitten by a tick.

The most common symptom is a target-like rash that moves around the body. However, many patients do not notice or develop a rash. In these cases, laboratory testing is needed for a diagnosis.

Other symptoms might include fever, chills, headache, fatigue, neck stiffness or muscle aches. In late stages, some patients also develop arthritis.

Because Lyme disease is caused by bacteria that can affect the nervous system, it can sometimes cause dysfunction of the facial nerve (the nerve that controls how we move our face to smile, pucker our lips, blink and more).

About five percent of patients with Lyme disease will develop some degree of sudden facial weakness (or “facial palsy”), where one or both sides of the face droop. Known as Lyme disease-associated facial palsy, this tends to occur seven to 21 days after tick exposure in infected patients. Anyone who experiences sudden facial palsy should be urgently assessed by a physician to establish the appropriate diagnosis. 

Getting the Right Treatment

Lyme disease-associated facial palsy may look a lot like Bell’s palsy— another cause of sudden facial weakness. But the two conditions are not the same.

Though more research is needed, a recent study from Mass. Eye and Ear suggests that patients with Lyme disease-associated facial palsy might develop worse long-term outcomes when treated with the same regimen used to treat patients with Bell’s palsy.

Since Lyme disease is a bacterial infection, it requires antibiotic therapy. Bell’s palsy is believed to be caused by a virus, and therefore is typically treated with corticosteroids and antivirals.

“In some cases of acute facial palsy, physicians will prescribe antibiotics, corticosteroids and antiviral medications while awaiting lab results for Lyme disease,” said Dr. Jowett. “While good evidence supports the use of corticosteroids in Bell’s palsy, their role as an add-on therapy for Lyme disease-associated facial palsy is currently unclear.”

Patients with Lyme disease-associated facial palsy and Bell’s palsy often experience different symptoms:

1. Patients with Bell’s palsy typically feel fine, whereas patients with Lyme disease-associated facial palsy often have flu-like symptoms. While changes in taste, ear pain and pain behind the ear occur frequently in both conditions, facial weakness that is accompanied by severe headaches, fever or chills, neck stiffness, severe fatigue or lethargy, back or abdominal pain or muscle aches is highly suggestive of Lyme disease.
2. Bell’s palsy typically involves only one side of the face, whereas Lyme disease can involve one or both sides.

The Road to Recovering Facial Movement

Recovery of facial function often begins within a few weeks; however, it may take up to three to four months before some Lyme disease-associated facial palsy patients see any sign of recovery — and up to 18 months before recovery is complete.

While all patients with Bell’s palsy or Lyme disease-associated facial palsy should recover facial tone and movement on the affected side, some will develop permanent facial muscle tightness, involuntary facial movements (such as involuntary eye closure) or restricted smile excursion. These long-term side effects can be effectively treated through targeted physical therapy, Botox® injections or surgical procedures.

The Bottom Line

“Patients who live in tick-infested areas should focus on prevention while outdoors,” said Dr. Jowett. “They can reduce their risk of infection by wearing pants and long-sleeve shirts, using appropriate chemical repellants and performing meticulous daily skin checks. Those at risk should seek medical care if they develop a target-like rash, sudden facial weakness or flu-like symptoms during tick season.”

About Our Expert

Nate Jowett, MD, FRCSC, is  a facial plastic and reconstructive surgeon in the Facial Nerve Center at Mass. Eye and Ear, where he specializes in the care of patients with facial nerve disorders.