Vázquez Marietta, Sparrow Sara S, Shapiro Eugene D
Department of Pediatrics and the Yale Children's Clinical Research Center, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
Pediatrics. 2003 Aug;112(2):e93-7. doi: 10.1542/peds.112.2.e93.
There is little information about the long-term outcomes of children with facial nerve palsy attributable to Lyme disease, a group putatively at high risk for poor neurologic outcomes.
The purpose of this study is to assess the long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease.
We conducted a matched cross-sectional study of children with facial nerve palsy in Connecticut who met the Centers for Disease Control and Prevention national surveillance case definition for Lyme disease. We identified children with facial nerve palsy attributable to Lyme disease from population-based data for the state of Connecticut from 1984 to 1991 as well as from selected clinical practices from 1984 to 1998. For each case, 2 controls without Lyme disease, matched by age, were selected by sequential digit dialing technique. Both patients and controls (or their parents) were interviewed using structured questionnaires. Outcomes included self/parents' reports both of symptoms and of abilities to perform normal daily activities since the diagnosis was made (or for an equivalent period of time for controls). In addition, the patients with facial nerve palsy attributable to Lyme disease were evaluated with a battery of neuropsychologic tests.
Of the 43 patients, 30% were female and 93% were white. Median age at diagnosis was 8 years (range: 2-18 years). Mean time to follow-up was 49 months (range: 7-161 months). Of the patients, 16% had been treated parenterally with ceftriaxone and 84% had been treated orally with either doxycycline or amoxicillin. Overall, 79% believed they were cured of Lyme disease, 9% believed they were not cured, and 12% did not know. The proportions of patients and of matched controls that reported increased problems with normal daily activities (eg, exercise, academic performance, word recall, sleeping) were similar. Patients with facial nerve palsy attributable to Lyme disease were more likely than matched controls to report symptoms of neck pain, changes in behavior, pains in joints or muscles, numbness or funny sensations in nerves, and problems with memory, but three quarters of them did not attribute these problems to Lyme disease. Twenty patients agreed to undergo neuropsychologic testing; all had average to above average scores on tests of IQ (eg, mean IQ was 110.2), memory, learning, attention, concentration, math, reading and spelling performance, executive functioning, abstract thinking, sequential processing, visuospatial scanning, and motor speed. There were no apparent differences in outcomes between children who received oral versus parenteral treatment.
The neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease 7 to 161 months earlier are comparable to those who did not have Lyme disease.
关于莱姆病所致面神经麻痹患儿的长期预后信息较少，这类患儿被认为有发生不良神经学预后的高风险。
本研究旨在评估莱姆病所致面神经麻痹患儿的长期神经心理学和健康预后。
我们对康涅狄格州符合美国疾病控制与预防中心莱姆病国家监测病例定义的面神经麻痹患儿进行了一项匹配横断面研究。我们从1984年至1991年康涅狄格州基于人群的数据以及1984年至1998年选定的临床实践中确定莱姆病所致面神经麻痹患儿。对于每例病例，通过顺序数字拨号技术选择2名无莱姆病的对照，按年龄匹配。使用结构化问卷对患者和对照（或其父母）进行访谈。结局包括自诊断以来（或对照的同等时间段）自我/父母报告的症状以及进行正常日常活动的能力。此外，对莱姆病所致面神经麻痹患者进行了一系列神经心理学测试。
43例患者中，30%为女性，93%为白人。诊断时的中位年龄为8岁（范围：2至18岁）。平均随访时间为49个月（范围：7至161个月）。患者中，16%接受了头孢曲松肠外治疗，84%接受了多西环素或阿莫西林口服治疗。总体而言，79%的人认为自己已治愈莱姆病，9%的人认为未治愈，12%的人表示不知道。报告正常日常活动问题增加（如运动、学业表现、单词回忆、睡眠）的患者和匹配对照的比例相似。莱姆病所致面神经麻痹患者比匹配对照更有可能报告颈部疼痛、行为改变、关节或肌肉疼痛、神经麻木或异常感觉以及记忆问题，但其中四分之三的人并不将这些问题归因于莱姆病。20例患者同意接受神经心理学测试；所有人在智商测试（如平均智商为110.2）、记忆、学习、注意力、专注力、数学、阅读和拼写表现、执行功能、抽象思维、顺序处理、视觉空间扫描和运动速度测试中的得分均为平均水平或高于平均水平。接受口服治疗与肠外治疗的儿童在结局方面无明显差异。
7至161个月前患莱姆病所致面神经麻痹的儿童的神经心理学和健康预后与未患莱姆病的儿童相当。
