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I read with interest Richard Davenport et al's useful and informative editorial on Bell's palsy in the August BJGP.1 It may be useful for GPs to be aware of some differences in the aetiology and therefore management of children with Bell's palsy for us on the south coast. As many will be aware, the New Forest in Hampshire near Southampton has traditionally been a hot spot for Lyme disease. Lyme disease can present in many ways; neuroborreliosis is the most common secondary manifestation of Lyme, and Bell's palsy the commonest presentation of neuroborreliosis. It is clear, however, that the tick which causes Lyme's is now more widespread and over the last 2 years in Winchester, north of the New Forest, we have seen cases of Lyme meningoencephalitis, arthritis, and multiple cases of Bell's palsy. A significant proportion of Bell's palsy have positive Lyme's serology; so much so that some of our consultants are considering Amoxil® or doxycycline (in the over 12's) as early ‘blind’ treatment options as well as the more traditional prednisolone with or without aciclovir as described in the editorial. Of note is the fact that very few of the group of Lyme serology positive Bell's palsy have had a history of a tick bite although many live in rural areas. Tick bites in children are often in the hair, hence very difficult to find and correctly identify.
I thought this information might be of use to GPs in the south, and perhaps with global warming may be more useful further afield!