Bloch Joakim, Schmidt Lisbeth, Vissing Nadja, Nielsen Alex Christian Yde, Glenthøj Jonathan Peter, Smith Birgitte, Lisby Jan Gorm, Nielsen Lene, Tetens Malte, Lebech Anne-Mette, Nygaard Ulrikka
Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
Acta Paediatr. 2025 Jan;114(1):122-130. doi: 10.1111/apa.17414. Epub 2024 Sep 2.
We aimed to investigate the causes of acute peripheral facial palsy (PFP) in Danish children and to explore whether neuroborreliosis-related PFP could be diagnosed without lumbar puncture using clinical symptoms and serum Borrelia burgdorferi (Bb) antibodies.
This retrospective population-based cohort study included children undergoing lumbar puncture for PFP between 2019 and 2023 in Denmark's Capital Region. Diagnostic performance measures for neuroborreliosis-related PFP were compared between serum Bb IgG alone and clinical risk scores combining Bb IgG with clinical parameters.
Of the 326 patients with PFP, 137 (42%) were diagnosed with neuroborreliosis and 151 (46%) had Bell's palsy. Positive predictive value for serum Bb IgG alone was 88% (95% CI 79-93) and negative predictive value was 83% (95% CI 75-88). The positive predictive value of a risk score with seven additional parameters was 90% (95% CI 81-95) and negative predictive value 87% (95% CI 80-92).
The positive predictive value of serum Bb IgG alone was high in our setting, where nearly half of children with PFP had neuroborreliosis. In high endemic settings, lumbar punctures may be reduced by (i) treating all children with PFP with doxycycline or (ii) treating Bb IgG positive children and performing lumbar puncture in seronegative children.
我们旨在调查丹麦儿童急性周围性面神经麻痹（PFP）的病因，并探讨是否可以在不进行腰椎穿刺的情况下，通过临床症状和血清伯氏疏螺旋体（Bb）抗体来诊断与神经莱姆病相关的PFP。
这项基于人群的回顾性队列研究纳入了2019年至2023年期间在丹麦首都地区因PFP接受腰椎穿刺的儿童。比较了单独血清Bb IgG与将Bb IgG与临床参数相结合的临床风险评分对与神经莱姆病相关的PFP的诊断性能指标。
在326例PFP患者中，137例（42%）被诊断为神经莱姆病，151例（46%）患有贝尔麻痹。单独血清Bb IgG的阳性预测值为88%（95%CI 79-93），阴性预测值为83%（95%CI 75-88）。包含七个额外参数的风险评分的阳性预测值为90%（95%CI 81-95），阴性预测值为87%（95%CI 80-92）。
在我们的研究环境中，单独血清Bb IgG的阳性预测值很高，其中近一半的PFP儿童患有神经莱姆病。在高流行地区，可通过以下方式减少腰椎穿刺：（i）用强力霉素治疗所有PFP儿童；或（ii）治疗Bb IgG阳性儿童，并对血清阴性儿童进行腰椎穿刺。
