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In children with facial nerve palsy caused by Lyme disease, there may be bilateral involvement in contrast to Bell palsy, in which weakness is always unilateral Additionally, facial nerve palsy can be the sole presenting symptom of Lyme disease Thus, even in the absence of other findings, serologic evidence for systemic Lyme infection should be sought in all children with isolated cranial nerve VII paresis in endemic areas The sensitivity of serologic testing increases with time after infection, so repeat titers are indicated in circumstances where suspicion is high but initial titers are negative An LP should be performed if there is evidence of meningoencephalitis such as severe headache or nuchal rigidity; however, the need for LP in a child at risk for Lyme disease with isolated facial nerve palsy is controversial For patients with facial nerve palsy due to Lyme disease, oral antibiotic treatment for 14 to 21 days is indicated as for other manifestations of early-disseminated Lyme disease (see Chapter 94 Infectious Disease Emergencies ) Parenteral antibiotics are reserved for those with findings of meningitis The effectiveness of steroids in such patients has not been evaluated Suggested Readings and Key References Seizures Bye A, Kok D, Ferenschild F Paroxysmal non-epileptic events in children: a retrospective study over a period of 10 years J Paediatr Child Health 2000;36(3):244–248 Committee on Quality Improvement; Subcommittee on Febrile Seizures Clinical practice guideline: febrile seizures: guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure Pediatrics 2011;127:389– 394 Glauser T, Shinnar S, Treiman DM, et al Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society Epilepsy Curr 2016;16(1):48– 61 Lyons TW, Johnson KB, Kimia AA, et al Yield of emergent neuroimaging in children with new-onset seizure and status epilepticus Seizure 2016;35:4–10 Rivello JJ, Ashwal S, Hirtz D, et al Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society Neurology 2006;637:1542–1550
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