Facial Paralysis Associated With Lyme Neuroborreliosis in Pediatric Patients: A Multicenter Retrospective Study in Eastern France From 2014-2020

Introduction: Lyme neuroborreliosis (LNB) is a recognized cause of peripheral facial paralysis (PFP) in children, particularly in endemic regions. Differentiating LNB from idiopathic facial paralysis at initial presentation remains challenging, as early biological confirmation may be delayed. This study aimed to determine the proportion of LNB among children presenting with facial paralysis at two tertiary pediatric centers in Eastern France, to identify clinical, epidemiological, and biological characteristics associated with LNB, and to evaluate local diagnostic and therapeutic practices in order to propose an updated management algorithm. Methods: We conducted a multicenter retrospective study including patients under 18 years of age presenting with facial paralysis at the pediatric hospitals of Nancy (January 2014 to December 2018) and Reims (January 2014 to December 2020), France. Patients were identified using ICD-10 codes and classified according to final diagnosis. Demographic, epidemiological, clinical, biological, and therapeutic data were extracted from electronic medical records. Comparative analyses were performed to identify characteristics associated with LNB and to evaluate diagnostic and treatment practices. Results: Among 159 children with facial paralysis, 18 (11.3%) were diagnosed with LNB. Clinical features more frequently observed in LNB included general symptoms (44.4% vs. 15.6%, p<0.05) and associated neurological signs (44.4% vs. 22%, p<0.05). Tick bite history and erythema migrans were infrequently reported. Biological findings such as positive Borrelia serology and cerebrospinal fluid lymphocytic pleocytosis were observed in patients with LNB and contributed to diagnostic confirmation. Complete recovery rates did not differ significantly between groups. Conclusion: In this endemic region, LNB accounted for a substantial proportion of pediatric facial paralysis cases. Early clinical features, particularly general and neurological symptoms, may help guide diagnostic evaluation before biological confirmation. These findings support the development of a structured management algorithm adapted to endemic settings to improve diagnostic accuracy and optimize patient care.