Long-term clinical outcomes after Lyme neuroborreliosis in children

Lyme neuroborreliosis (LNB) is a tick-borne infection caused by spirochetes of the Borrelia burgdorferi sensu lato complex. Facial nerve palsy and subacute meningitis are the most prevalent neurological manifestations. Long-term prognosis is a major concern of many parents. These concerns relate to persisting neurological deficiencies as well as long-term non-specific symptoms such as fatigue. The aim of this study is to determine long-term outcome in pediatric LNB by using patient-reported outcome measures (PROMs) of facial impairment and self-reported fatigue and to compare these outcomes between children with LNB and idiopathic facial nerve palsy (IFP).

A long-term follow-up study was performed including all children (< 18 years) who visited the departments of pediatrics, neurology, or otorhinolaryngology of Gelre hospitals Apeldoorn and Zutphen between 1 January 2010 and 31 December 2023 with the diagnosis LNB or IFP. After consent, children and/or parents (or guardians) were invited to complete an electronic questionnaire, including the Facial Clinimetric Evaluation (FaCE) scale and the Checklist Individual Strength (CIS).

During the study period, 105 children were identified with facial nerve palsy and 4 with LNB with only headache. These 4 patients with meningitis but without facial nerve palsy were not included in further analyses. Seven children were lost to follow up. In total, 102 children were invited to complete the questionnaires, of which 84 responded (82%) after a median follow-up period of 93.5 months after the acute facial nerve palsy. The median total score of the FaCE scale was 99.2 (IQR 89.2-100) in children with LNB and 98.3 (IQR 93.3-100) in children with IFP and results did not differ between groups (p = 0.787). There were no significant differences between patients with LNB and IFP in the CIS total score (median (IQR), respectively 42.0 (26.3-69.5) versus 48.0 (40.3-60.5) (p = 0.301)).

This long-term follow-up study adds new data on self/parent reported disease specific outcomes in children with facial nerve palsy from two important patient groups (LNB and IFP). Both facial impairment and fatigue were uncommon and did not differ between LNB and IFP patients at long-term follow-up.