Pediatric emergency medicine trisk 2653 2653

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.