Prevalence of Lyme disease in patients with peripheral facial palsy in the province of Quebec: a prospective multicenter Canadian study.

Abstract

Objectives: Lyme disease is a recognized cause of peripheral facial palsy, but its estimated prevalence in affected patients varies widely, ranging from 2 to 65%. There are no clear guidelines to assist clinicians in the empiric management of undifferentiated peripheral facial palsy in regions where Lyme disease is prevalent. This prospective multicenter study aimed to determine the prevalence of Lyme disease-associated facial palsy in patients presenting with peripheral facial palsy in four emergency departments in the most endemic regions of Quebec, Canada (Estrie and Montérégie).

Methods: Emergency physicians at four Quebec hospitals completed a brief online questionnaire for each patient presenting with peripheral facial palsy from February 2022 to September 2023; they were also encouraged to order Lyme disease testing. A subsequent search was conducted in the electronic medical records of each participating hospital to retrieve Borrelia burgdorferi serology results (ELISA and/or Western blot).

Results: Among the 83 patients who consulted for peripheral facial palsy, Lyme disease serology testing was performed in 68 cases. Of these, only two had a positive ELISA screening test. None of these patients had a confirmed diagnosis based on confirmatory Western blot testing.

Conclusions: The findings of this study indicate a low prevalence of Lyme disease among patients presenting with peripheral facial palsy in Quebec. While the authors recommend testing for Lyme disease as per local guidelines in patients presenting with peripheral facial palsy in endemic regions, empiric treatment should not be routinely initiated in the absence of other clinical signs or symptoms suggestive of the disease given the absence of confirmed cases in this cohort.