• Lise E Nigrovic, Amy D Thompson, Andrew M Fine, and Amir Kimia.
• Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts 02115, USA. lise.nigrovic@childrens.harvard.edu
• Pediatrics. 2008 Nov 1; 122 (5): e1080-5.

IntroductionAlthough Lyme disease can cause peripheral facial palsy in Lyme disease-endemic areas, diagnostic predictors in children have not been described.ObjectiveOur goal was to determine clinical predictors of Lyme disease as the etiology of peripheral facial palsy in children presenting to an emergency department in a Lyme disease-endemic area.MethodsWe reviewed all available electronic medical charts of children ResultsWe identified 313 patients with peripheral facial palsy evaluated for Lyme disease. The mean age was 10.7 years, and 52% were male. Of these, 106 (34%) had Lyme disease facial palsy. After adjusting for year of study, the following were independently associated with Lyme disease facial palsy: onset of symptoms during peak Lyme disease season (June to October), absence of previous herpetic lesions, presence of fever, and history of headache. In the subset of patients without meningitis, both onset of symptoms during Lyme disease season and presence of headache remained significant independent predictors.ConclusionsLyme disease is a frequent cause of facial palsy in children living in an endemic region. Serologic testing and empiric antibiotics should be strongly considered, especially when children present during peak Lyme disease season or with a headache.

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