Abstract 1033 Poster Session IV, Tuesday, 5/4 (poster 129)

There is little information about the long-term outcomes of children with facial nerve palsy due to Lyme disease. To assess their long-term outcomes, we conducted a longitudinal cohort study of children with facial nerve palsy in Connecticut who met the CDC's case definition for Lyme disease. We identified children with facial nerve palsy due to Lyme disease from population-based data for the state of Connecticut as well as from selected clinical practices. For each case, two controls without facial nerve palsy or Lyme disease, matched by age and location, were selected by random digit dialing. Patients and controls (or their parents) were interviewed using standardized questionnaires. Outcomes included self/parents′ reports of symptoms and of abilities to perform normal daily activities since the diagnosis was made (or an equivalent period of time for controls). In addition, comprehensive neuropsychological tests (Standford Binet IQ Test, Children's Memory Scale or Weschler Memory Scale, Trail Making Test, Wisconsin Card Sorting Test, Kaufman Test of Educational Achievement) were administered to patients only.

Of the 43 patients, 30% were female and 93% were Caucasian. Median age at diagnosis was 9 yrs (range 2-19 yrs). Median time to follow-up was 41 months (range 9-94 mos). Of the patients, 16% were treated parenterally with ceftriaxone and 84% were treated orally with either doxycycline or amoxicillin. Overall, 79% believed they were cured, 9% believed they were not cured and 11% did not know. Among those treated parenterally, 71% believed they were cured and 29% did not know. There were no apparent differences in outcomes between children who received oral vs. parenteral treatment. The proportions of patients and of controls that reported increased problems with normal daily activities (eg, exercise, academic performance, word recall, sleeping) were not significantly different. Patients with facial nerve palsy due to Lyme disease were more likely than matched controls to report symptoms of funny sensations in the nerves (P=0.03), pain in the joints or muscles (P=0.03), and neck pain (P=0.001), but three-quarters of them did not attribute these problems to Lyme disease; there were no significant differences in the proportions of patients and of controls that reported increases in symptoms of joint swelling, headaches, fatigue or problems with memory. Thus far, 20 patients have undergone neuropsychologic testing; all had normal to above average scores on tests of memory, IQ, learning, abstract thinking, visuospatial scanning, motor speed, sequential processing, attention, and concentration (e.g., mean IQ was 111.3; range: 86-145). We conclude that the long-term outcomes of children with facial nerve palsy due to Lyme disease are excellent.