Steroid Use Questioned for Common Lyme Disease Manifestation

Compared to antibiotic monotherapy, corticosteroid use in the treatment of Lyme disease-associated facial paralysis may actually worsen outcomes for patients. Findings of this long-term study were published online in the journal Laryngoscope.

Researchers from the Massachusetts Eye and Ear and Harvard Medical School followed 51 patients with Lyme disease-associated facial paralysis – a common manifestation of the disease – for an average of 15 months.

Patients were grouped into those who were treated with antibiotics, antivirals and corticosteroids, those who were treated with just antibiotics and corticosteroids, and those treated with antibiotics alone. Experts blinded to each patient’s treatment received videos of a standardized sequence of facial expressions for all patients. They used validated, standardized tests to measure the outcomes of patients with facial paralysis. 

Results showed that patients who received corticosteroids had worse outcomes than those who received antibiotics alone. The authors point out that no established role for corticosteroids in the setting of acute Lyme disease or Lyme disease-associated facial paralysis exists, and previous studies have demonstrated no benefit of their use.

Considering this lack of literature, Nate Jowett, MD, FRCSC and lead author said, “We urge strong caution in prescribing corticosteroids in cases where facial paralysis is clearly the result of acute Lyme disease until better evidence is available.”

It’s estimated that 300,000 Americans are infected with Lyme’s disease each year. Most patients who experience facial paralysis regain normal function however some develop a permanent synkinesis on the involved side of their face.

“Since corticosteroids are part of the standard of care for acute viral facial paralysis, it is not surprising that they were initially prescribed to roughly two-thirds of the patients with Lyme disease-associated facial paralysis in this study. Our findings underline the importance of differentiating patients with facial weakness due to Lyme disease — for whom the standard of care is prompt antibiotic therapy — from those with acute viral facial paralysis, such as Bell’s palsy or varicella-zoster virus – for whom the standard of care includes early treatment with corticosteroids and antivirals,” said Dr. Jowett.

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