SEARCH FOR LYMES-DISEASE IN FACIAL PALSY - A PROSPECTIVE MULTICENTRICSTUDY IN FRANCE

Objectives: Apparent a frigore facial palsy could possibly mask manife stations of unrecognized Lyme's disease. Since commonly used corticost eroid treatment could be deleterious if Borrelia burgdorferi infection was indeed the cause, we conducted a prospective study to search for possible infections in cases of recently diagnosed a frigore facial pa lsy. Methods: For 3 years, 1990-1992, 49 French centres diagnosed a fa cial palsy in 346 patients (310 adults, 36 children under 15 years of age; mean age 38; range 16 months to 83 years). The patients were divi ded into three groups: a) facial palsy alone, b) zoster origin recogni zed due to outer ear eruption and c) cases with meningoradiculitis or joint signs or cases with facial diplegia. A questionnaire was used to evaluate exposure to risk of tick bits. A control group was establish ed with 246 serum samples from subjects matched with the patients for age, geographical origin and exposure to risk of tick bits. Laboratory tests (indirect immunofluorescence and Western blot) were performed t o search for anti-Borrelia burgdorferi antibodies in serum samples, an d cerebral spinal fluid when possible, collected at presentation, on d ay 30 and on day 90. Results: Sixty percent of the patients were urban dwellers, 15% lived in rural and 25% in semi-rural areas. There were 294 patients with facial palsy alone and their serum results were comp ared with those of the matched controls. There tvas no significant dif ference in the positivity for Borrelia burgdorferi antibodies between these two groups. Conclusion: These findings indicate that, unless the re are clinical signs suggestive of borreliosis, it would not be neces sary to test for Lyme's disease in patients with apparent a frigore fa cial palsy.