Global Lyme Alliance scientific advisory board member, Dr. Adriana Marques, led a study on Lyme neuroborreliosis patients, who take corticosteroids in addition to antibiotics, and whether or not the treatment had a negative effect on facial palsy recovery.
Lyme disease is conventionally divided into three clinical stages: early, early disseminated, and late disseminated. The disseminated stages occur when the Lyme disease bacterium, Borrelia burgdorferi, travels from the initial tick bite site in the skin to the rest of the body, such as the heart, joints, and nervous system. Once B. burgdorferi has spread to the nervous system, it is called Lyme neuroborreliosis. The most common symptoms in Lyme neuroborreliosis include:
- Cranial palsy (loss of nerve function in the face leading to facial drooping, often on one side which is known as Bell’s palsy)
- Meningitis (inflammation of the protective membranes covering the brain and spinal cord)
- Radiculoneuritis (numbness, tingling, or shooting pain from inflamed nerves).
Lyme neuroborreliosis occurs in about 15% of untreated Lyme patients in the US, and there are few studies describing treatment and recovery for facial palsy. Corticosteroids have been shown to improve facial palsy when a bacterial infection is not suspected, but the impact of dual therapy with antibiotics and corticosteroids on facial palsy is not well established.
Dr. Adriana Marques, one of GLA’s scientific advisory board members, recently led a retrospective study on Lyme neuroborreliosis patients to determine if treatment with corticosteroids in addition to antibiotics had any negative impacts on facial palsy recovery. After reviewing patient data from clinical studies spanning from 1997 to 2017, they found that out of 486 patients, 44 had facial palsy associated with Lyme neuroborreliosis. Thirty-one of these patients had paralysis on one side of their face (unilateral palsy) and the other 13 patients presented with paralysis on both sides of their face (bilateral palsy). Out of the patients that had a complete follow-up, 14 received antibiotics, while 24 received a dual treatment of antibiotics and corticosteroids. For these 38 patients, 34 had complete recovery, 3 almost recovered completely, and 1 still had some paralysis. The addition of corticosteroids to patient treatment regimens did not impact their speed or ability to regain facial nerve function. Therefore, antibiotic treatment alone is highly effective at resolving facial palsy in patients with Lyme neuroborreliosis.
These study findings are very important when considering how best to treat patients with neuroborreliosis because despite their significant efficacy, there can be many adverse effects associated with long-term and/or high-dose use of corticosteroids. The most common adverse effects to name a few include osteoporosis and fractures, diabetes and hyperglycemia, glaucoma and cataracts, psychiatric disturbances, immunosuppression, cardiovascular disease, gastrointestinal and dermatologic effect. [1] Given that Dr. Marques’ group found no benefit to including corticosteroids as part of a treatment regimen, avoiding their use carries no downside for a patient with neurological Lyme disease.
This study also underscores why Dr. Adriana Marques, Chief of the Clinical Studies Unit in the Laboratory of Immunology and Microbiology at the National Institute of Allergy and Infectious Diseases, was invited to be a member of GLA’s scientific advisory board. As a scientific advisory board member, she reviews grants with a critical eye and advises our team on which research projects are most likely to produce impactful results. Dr. Marques’ expertise in designing clinical studies and experience as an internal medicine provider make her an invaluable scientific advisory board member and her guidance gets us closer to making our vision of improving patient lives a reality.
[1] Hodgens A, Sharman T. Corticosteroids. [Updated 2021 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/
