• Anna Moniuszko-Malinowska, Katarzyna Guziejko, Agata Czarnowska, Alina Kułakowska, Olga Zajkowska, Sławomir Pancewicz, Renata Świerzbińska, Justyna Dunaj, Piotr Czupryna, Magdalena Róg-Makal, and Joanna Zajkowska.
• Department of Infectious Diseases and Neuroinfections, Medical University of Bialystok, Bialystok, Poland.
• Int. J. Clin. Pract. 2021 Mar 1; 75 (3): e13749.

AimThere are many causes of facial nerve palsy. The most common causes are neuroborreliosis (NB), idiopathic paralysis or Herpes simplex virus (HSV) reactivation. The aim of this study was to characterize patients with facial palsy in the course of NB and to determine whether HSV-1 reactivation takes place during the acute phase of NB.MethodsA retrospective analysis of 66 patients with facial nerve palsy was performed. In 38 patients, facial palsy was caused by Borrelia burgdorferi sl infection. Immunological tests for HSV-1, tick-borne encephalitis virus and B burgdorferi sl in serum and cerebrospinal fluid (CSF) were performed.ResultsIn this analysis, 55.2% of NB patients had right nerve palsy and 21% bilateral palsy; 15.8% of patients had erythema migrans (EM). Lymphocytic meningitis was diagnosed in 92% of patients and Bannwarth's syndrome was diagnosed in 47% of patients. IgM anti-HSV-1 antibodies were detected in four patients with NB and two patients with facial nerve palsy of other origin. IgM anti-HSV-1 antibodies were detected in the CSF of three patients (7.9%) with NB, and one of them had bilateral VII paresis and EM simultaneously. Treatment with ceftriaxone or doxycycline led to complete recovery.ConclusionsNeuroborreliosis should always be considered as a cause of peripheral facial nerve palsy. Peripheral facial nerve palsy is a significant symptom in the course of NB, especially in patients accompanied by meningitis. Pathomechanism of facial nerve paresis has not been well explained so far and may depend on two independent mechanisms in NB, including HSV-1 reactivation.© 2020 John Wiley & Sons Ltd.

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