NYMC Faculty Publications

FACE DROPS a Clinical Risk Assessment Tool for Differentiation of Acute Lyme Disease–Associated Facial Palsy From Bell Palsy

Author Type(s)

Faculty

DOI

10.1212/CPJ.0000000000200476

Journal Title

Neurology Clinical Practice

Document Type

Article

Publication Date

4-18-2025

Department

Medicine

Disciplines

Medicine and Health Sciences

Abstract

Background and Objectives Facial palsy is a common manifestation of Lyme disease, accounting for up to 5% of acute facial palsies in endemic regions. Lyme disease–associated facial palsy (LDFP) warrants prompt antibiotic therapy while corticosteroid therapy is indicated for Bell palsy. The role of adjuvant corticosteroids in the treatment of acute LDFP is unclear. Current limitations of diagnostic laboratory tests for Lyme disease render acute differentiation of LDFP and BP challenging in many cases. Methods We reviewed records from 285 patients with LDFP (N = 76) and BP (N = 209) referred to a specialized facial nerve center from 2005 to 2021 to determine clinical characteristics at time of presentation to medical care. We developed and internally validated a clinical risk assessment tool (“FACE DROPS”) based on pertinent differences between signs and symptoms of LDFP and BP at presentation. Results The risk assessment tool distinguishes LDFP from BP using 7 clinical criteria: fever (+8 to FACE DROPS score), aches (arthralgia/myalgia; +6), cephalalgia (headache; +3), exhaustion (unusual fatigue; +4), dermatomal or radicular pattern (transverse myelitis or radiculitis; +4), otalgia or postauricular pain (−1), and stiff neck (nuchal rigidity; +3). FACE DROPS scores ≤4 predicted BP with ≥93.5% accuracy while scores of ≥7 predicted LDFP with ≥96.0% accuracy. Discussion A novel risk assessment tool to distinguish LDFP from BP was developed. This tool may help guide the prescribing of antimicrobials for Lyme disease in the setting of acute facial palsy pending confirmatory laboratory evidence in the absence of an erythema migrans skin lesion.

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