Bell’s Palsy or Lyme Disease? How to Spot the Difference
Understanding Bell’s Palsy
Bell’s palsy is a form of sudden, temporary paralysis of the facial
muscles, usually on one side of the face. It results from inflammation or
swelling of the facial nerve, which controls facial expressions. The exact
cause of Bell’s palsy isn’t fully understood, but researchers believe it’s
often triggered by a viral infection – commonly the herpes simplex virus that
causes cold sores. This viral reactivation causes the facial
nerve to swell and become compressed in the narrow bony canal in the skull,
leading to nerve dysfunction.
Bell’s palsy symptoms typically come on very quickly. Patients
often wake up unable to move the muscles on one side of their face, or notice a
rapid deterioration over 24 to 48 hours. The hallmark is facial droop: the eyelid and
corner of the mouth on the affected side droop because the nerve can’t signal
those muscles. This can make it impossible to fully close one eye or smile on
that side. Other symptoms can include drooling, tearing of the eye,
and pain around the jaw or behind the ear on the affected side. Some
people have heightened sensitivity to sound (noises may seem louder
in the affected ear) or changes in taste sensation. Despite these upsetting
symptoms, Bell’s palsy is typically not permanent. Most
individuals begin to improve within a few weeks and achieve complete
recovery within three to six months. In fact, about 70–75% of Bell’s palsy
patients recover full facial function within 3 months. The condition can occur at any age, but it’s
most common in people between ages 15 and 60.
The sudden onset of facial
paralysis in Bell’s palsy can be frightening and emotionally distressing.
Patients often worry they are having a stroke. It’s important to note that
Bell’s palsy affects only the facial nerve, so it will not cause other neurological
symptoms like arm weakness or difficulty speaking (which are seen in strokes).
Still, whenever someone experiences new facial paralysis, they should get
medical attention promptly to confirm the diagnosis and rule out other causes.
Recognizing Lyme Disease and Facial Palsy
Lyme disease is a multisystem infection caused by the
bacterium Borrelia burgdorferi, transmitted through the bite of
infected ticks. Early Lyme disease typically causes symptoms
like fever, chills, fatigue, headache, muscle and
joint aches, and often a characteristic skin rash known as erythema
migrans (or bull’s-eye rash) at the site of the tick bite. Not everyone with Lyme gets the rash, but
its presence is a strong clue. If Lyme disease is not treated promptly, the
infection can spread through the bloodstream to various parts of the body,
including the nervous system – this stage is called neuroborreliosis.
When Lyme disease affects the nervous system, one possible manifestation
is Lyme neuropathy of the facial nerve, which leads to facial weakness or
paralysis just like Bell’s palsy. In fact, facial palsy can be an early sign
of disseminated Lyme disease, sometimes occurring weeks after the initial tick
bite. Lyme-related facial palsy might be accompanied by other neurologic
symptoms such as severe headache, stiff neck, shooting nerve
pains, or meningitis-like symptoms (since Lyme can cause inflammation
of the brain’s lining). Patients may also have ongoing fever, swollen lymph
nodes, or migratory pain in joints and tendons, reflecting the infection’s widespread
nature.
Key Differences in Symptoms
Distinguishing Bell’s palsy from Lyme disease involves looking at
the context and accompanying symptoms of the facial weakness.
Here are some clues that point to one or the other:
- Onset and Timing:
Bell’s palsy tends to appear very suddenly,
often reaching peak paralysis within 48 hours. If you went to bed normal and woke up with a
drooping face, Bell’s palsy is a prime suspect. Lyme disease, on the other
hand, usually unfolds a bit more gradually. The tick bite may have occurred
weeks earlier; initial flu-like symptoms might have come and gone. Facial
paralysis from Lyme can develop several weeks after infection, rather than
overnight. It might also be part of a larger pattern of symptoms that evolved
over days (like headaches or joint aches that preceded the facial droop). So, rapid
onset favours Bell’s palsy, whereas a more stepwise onset or one
tied to recent outdoor tick exposure leans toward Lyme.
- Presence of a Rash:
One of the hallmark signs of Lyme disease is
the bull’s-eye rash (erythema migrans). About 70–80% of people with
Lyme develop this expanding red rash at the site of the tick bite, usually
within a week or two of the bite. If a patient with facial palsy remembers a
recent tick bite or has (or had) such a rash, Lyme disease is very likely the
cause. Bell’s palsy does not cause
any rash – it’s confined to the facial nerve. So, a rash (especially with
a target appearance) is a big clue for Lyme. Conversely, the absence of a
rash doesn’t rule out Lyme entirely (some patients never notice one), but its
presence is very telling.
- Systemic and Other Symptoms:
Bell’s palsy is generally isolated to the
face. Aside from possible mild ear/jaw pain or altered taste, you wouldn’t
expect systemic illness. The person typically feels otherwise well. In Lyme
disease, facial palsy often comes with other hints of infection. Fever,
chills, fatigue, or body aches strongly suggest an infectious cause like
Lyme. Also, Lyme may produce symptoms indicating
other nerve involvement – for example, numbness in limbs, migrating joint
pains, or heart palpitations. Neck stiffness and headache might
indicate meningitis caused by Lyme. In summary, Lyme tends to make you
sick in ways beyond just the face, whereas Bell’s palsy usually doesn’t.
- Facial Pain:
Both conditions can sometimes involve pain,
but the character differs. Bell’s palsy patients occasionally have pain behind
the ear or along the jaw on the affected side due to the inflamed facial nerve.
Lyme disease might cause more diffuse head or neck pain if meningitis is
present.
Treatment Options for Bell’s Palsy
Treatment for Bell’s palsy aims to reduce nerve
inflammation and protect the eye on the affected side (since blinking is
impaired). The mainstay therapy is corticosteroids (like prednisone).
Steroid pills, given typically within 72 hours of symptom onset, can
significantly improve the likelihood of full recovery by reducing swelling of
the facial nerve. A typical course lasts about a week. Many
patients notice improvement in facial movement after the steroid course.
Eye care is extremely important in Bell’s palsy. Because you may
not be able to fully close one eye, that eye is at risk of drying out or
getting irritated. Frequent use of lubricating eye drops (artificial
tears) during the day and an eye ointment at night are recommended to keep the
eye moist. Often, doctors also advise taping the eyelid shut or using an eye
patch during sleep to protect the cornea. This prevents scratches and ulcers on
the eye, which can occur if the eye stays slightly open. Wearing glasses or
sunglasses can shield the affected eye from dust and bright light, which might
be bothersome when blinking is impaired.
Managing Lyme Disease and Its Facial Palsy
When Lyme disease is identified as the cause of facial palsy, the
treatment is entirely different: it revolves around antibiotics to
eliminate the Borrelia infection. For early Lyme disease
affecting the facial nerve, the recommended treatment is usually oral
antibiotics for 2 to 4 weeks. In cases where there are signs of central nervous
system involvement (like meningitis) or the patient cannot take oral
meds, intravenous antibiotics may be used.
During treatment, the management of the facial palsy
symptoms is similar to Bell’s palsy: protecting the eye and doing facial
exercises can be helpful. Steroids, which are so useful in Bell’s palsy, are
generally not recommended in Lyme disease facial palsy because they
could suppress the immune response to the infection.
Prognosis and Recovery Outlook
One of the most frequent questions patients have is: will I get back to
normal? The encouraging news is that the prognosis for Bell’s palsy is
generally excellent. The majority of patients recover completely within a few
months. Younger patients tend to recover more fully,
but even older individuals often see great improvement. A minority may have
some lasting minor weakness or twitching, but it’s usually subtle. Emotional
support and patience are important during recovery, because having a droopy
face can impact self-esteem and social interactions. Knowing it’s temporary and
working on any residual weakness with therapy can help people cope.
In Lyme disease, if treated appropriately, the prognosis is also quite good. Early treatment of Lyme leads to a high cure rate, and the facial palsy usually resolves along with the infection. Most patients will recover facial nerve function, though it may take time.
Conclusion
Facial paralysis can be terrifying, but identifying the cause – Bell’s
palsy or Lyme disease – is the first step toward proper treatment and peace of
mind. If you or someone you know develops facial drooping or weakness,
see a healthcare provider promptly. With timely intervention, the outlook for
both conditions are generally very good, and most people can expect to regain
their smile.
Sources:
- Your Health Magazine – Bell’s Palsy or Lyme
Disease?
- Your Health Magazine – Ibid. (Diagnosis
and Treatment sections)
- Global Lyme Alliance – Lyme Disease Facial
Palsy: Difference Between Bell’s Palsy & Lyme
- Massachusetts Eye and Ear Infirmary – Lyme
Disease and Facial Weakness
- National Institute of Neurological Disorders
and Stroke – Bell’s Palsy Fact Sheet
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