Department of Infectious and Tropical Diseases, CHU Besançon, 25000, Besançon, France.
Service de Pédiatrie, CHRU Besançon, Besançon, France.
Eur J Pediatr. 2024 Dec;183(12):5363-5370. doi: 10.1007/s00431-024-05780-4. Epub 2024 Oct 10.
The diagnosis and management of facial nerve palsy in children in Lyme borreliosis endemic area can be complex. The objective of this study was to evaluate the diagnosis and management of children with suspected Lyme neuroborreliosis (LNB)-related facial nerve palsy by general practitioners (GP) and paediatricians. We conducted a prospective national survey of clinical practice between September 2018 and January 2020. The questionnaire was intended for GPs and paediatricians. It is based on two distinct clinical situations (a 10-year-old child and a 5-year-old child) and contains questions about the diagnosis and management of facial nerve palsy in children with a recent tick bite. We obtained 598 responses (350/4125 paediatricians and 245/577 GPs). For a 10-year-old child with a facial nerve palsy in the context of a tick bite, more than half of GPs (52%) required a paediatric infectious consultation and 18% an admission to the hospital for lumbar puncture before the result of Lyme serology. The most prescribed antimicrobial therapies were amoxicillin (32%) and ceftriaxone (29%). For a 5-year-old child, there is no difference in the diagnosis of LNB and treatment except for doxycycline which was less prescribed. Concerning treatment, 18% of practitioners prescribed antibiotic therapy only (14% of GPs vs 21% of paediatricians, p = 0.09), and 17% prescribed antibiotic therapy combined with corticosteroids (14% of GPs vs 19% of paediatricians, p = 0.15). Finally, 93% of GPs and 75% of paediatricians reported to be uncomfortable with the diagnosis of LNB in children.
Most participants were uncomfortable with the diagnosis of LNB. There was a limited difference in the management of LNB in children between GPs and paediatricians.
• Lyme neuroborreliosis (LNB) is the second cause of facial nerve palsy in Europe, and its diagnosis is based on neurological symptoms and a lumbar puncture. However, no clinical criteria could be used to differentiate Bell's palsy and LNB. Moreover, data on the adjunctive corticosteroid treatment and outcome in patients with LNB-related facial nerve palsy are controversial.
• Most participants were uncomfortable with the diagnosis of LNB. Its management was heterogeneous and most often not consistent with guidelines. Only 28% of participants requested a lumbar puncture in cases of suspected LNB, and 17% prescribed antibiotics with corticosteroids. • This study highlights the need for new specific guidelines in management (need for lumbar puncture and/or LB serology) and treatment (time to antibiotic initiation, probabilistic therapy, role of corticosteroids, doxycycline in children younger than 8 years) of LNB in children.
评估全科医生和儿科医生对莱姆病流行地区儿童面神经麻痹的诊断和管理。
我们进行了一项全国性的前瞻性临床实践调查，时间为 2018 年 9 月至 2020 年 1 月。问卷面向全科医生和儿科医生。它基于两种不同的临床情况（10 岁儿童和 5 岁儿童），包含有关近期蜱叮咬儿童面神经麻痹诊断和管理的问题。我们共收到 598 份回复（350/4125 名儿科医生和 245/577 名全科医生）。对于 10 岁有蜱叮咬背景的面神经麻痹患儿，超过一半的全科医生（52%）在莱姆血清学结果出来之前，需要儿科传染病会诊和 18%的住院腰椎穿刺。最常开的抗菌治疗药物是阿莫西林（32%）和头孢曲松（29%）。对于 5 岁儿童，除了较少使用的多西环素外，莱姆病神经Borreliosis（LNB）的诊断和治疗没有差异。关于治疗，18%的医生仅开抗生素治疗（14%的全科医生和 21%的儿科医生，p=0.09），17%的医生开抗生素联合皮质类固醇治疗（14%的全科医生和 19%的儿科医生，p=0.15）。最后，93%的全科医生和 75%的儿科医生表示对儿童 LNB 的诊断感到不舒服。
大多数参与者对 LNB 的诊断感到不舒服。全科医生和儿科医生在儿童 LNB 的管理上存在差异。
欧洲面神经麻痹的第二大原因是莱姆神经Borreliosis（LNB），其诊断基于神经症状和腰椎穿刺。然而，没有临床标准可以区分贝尔氏麻痹和 LNB。此外，关于 LNB 相关面神经麻痹患者的皮质类固醇辅助治疗和结果的数据存在争议。
大多数参与者对 LNB 的诊断感到不舒服。其管理方法存在差异，且通常与指南不一致。只有 28%的参与者在疑似 LNB 时要求进行腰椎穿刺，17%的参与者开了抗生素联合皮质类固醇。
本研究强调了需要制定新的特定指南，包括管理（疑似 LNB 时是否需要腰椎穿刺和/或 LB 血清学检查）和治疗（抗生素开始时间、概率治疗、皮质类固醇作用、8 岁以下儿童的多西环素）。
