Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg,Sweden.
Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clin Infect Dis. 2021 Oct 5;73(7):1211-1215. doi: 10.1093/cid/ciab370.
Lyme neuroborreliosis peripheral facial palsy (LNB PFP) and idiopathic PFP, Bell's palsy (BP), are the most common causes of facial palsy in borrelia-endemic areas and are clinically similar. Early treatment with corticosteroids has been shown to be effective in Bell's palsy, and antibiotics improve the outcome in LNB. However, there is a lack of knowledge on how the addition of corticosteroids to standard antibiotic treatment affects the outcome in LNB PFP.
This prospective, open trial with historical controls was conducted at 2 large hospitals in western Sweden between 2011 and 2018. Adults who presented with LNB PFP were included in the study group and were treated with oral doxycycline 200 mg twice daily for 10 days and prednisolone 60 mg once daily for 5 days, then tapered over 5 days. The historical controls were adult patients with LNB PFP included in previous studies and treated with oral doxycycline. Both groups underwent a follow-up lumbar puncture and were followed until complete recovery or for 12 months.
Fifty-seven patients were included, 27 in the study group and 30 in the control group. Two patients (7%) in the study group and 6 patients (20%) in the control group suffered from sequelae at the end follow-up. There was no statistically significant difference between the groups, either in the proportion of patients with sequelae or in the decline in cerebrospinal fluid mononuclear cell count.
Adjunctive corticosteroids neither improve nor impair the outcome for patients with LNB PFP treated with doxycycline.
莱姆神经伯氏疏螺旋体病（LNB）周围性面瘫（PFP）和特发性 PFP、贝尔氏面瘫（BP）是伯氏疏螺旋体病流行地区最常见的面瘫原因，临床表现相似。早期皮质类固醇治疗对贝尔氏面瘫有效，抗生素改善 LNB 的预后。然而，对于在 LNB PFP 中添加皮质类固醇对标准抗生素治疗的结果如何，目前还缺乏了解。
这是一项在 2011 年至 2018 年期间在瑞典西部的 2 家大型医院进行的前瞻性、开放性试验，具有历史对照。患有 LNB PFP 的成年人被纳入研究组，给予口服强力霉素 200mg，每日 2 次，共 10 天，泼尼松龙 60mg，每日 1 次，共 5 天，然后在 5 天内逐渐减少剂量。历史对照组为以前研究中纳入的患有 LNB PFP 的成年患者，接受口服强力霉素治疗。两组均进行随访腰椎穿刺，并随访至完全恢复或 12 个月。
共纳入 57 例患者，研究组 27 例，对照组 30 例。研究组中有 2 例（7%）患者和对照组中有 6 例（20%）患者在最终随访时留有后遗症。两组患者的后遗症比例或脑脊液单个核细胞计数下降均无统计学差异。
在接受强力霉素治疗的 LNB PFP 患者中，辅助皮质类固醇既不能改善也不能损害预后。
