Lyme Disease and Facial Paralysis: Late Symptoms

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Lyme disease is passed to humans through the bite of an infected black-legged tick that carries bacteria called Borrelia burgdorferi or, rarely, Borrelia mayonii. In most cases, the tick must be attached to the area for 48 hours before the bacteria can be transmitted.

Each year approximately 30,000 cases of Lyme disease are reported, but this number does not reflect all instances. Recent estimates suggest that nearly 476,000 people in the United States are treated for Lyme disease each year, but that number likely includes patients who were not actually infected.

Learn more about the signs of Lyme disease, including facial paralysis, diagnosis, and treatment of the disease.


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Early Signs of Lyme Disease

The earliest signs of Lyme disease typically occur between three and 30 days after infection.

Early Infection, Stage 1

About 70%–80% of infected people will get a rash called erythema migrans (EM). On average, this occurs around day seven but can happen later.

The rash begins at the site of the tick bite and expands. The red or bluish rash is usually circular and may or may not have central clearing. The rash can be warm to the touch but is rarely painful or itchy. The rash can enlarge and resemble a bull's-eye, or target, when it fades.

Other symptoms of Lyme disease include:

Early Infection, Stage 2

Within weeks or months after a tick bite, a person with Lyme disease may experience other symptoms, which can include:

  • Headaches and neck stiffness
  • Joint pain
  • Rashes on different parts of the body
  • Swelling of the large joints, such as the knees
  • Irregular heartbeat (Lyme carditis)
  • Nerve pain
  • Pain in the tendons, muscles, joints, and bones that come and go
  • Numbness, tingling, and shooting pain in the hands and feet
  • Dizziness or shortness of breath
  • Facial palsy

Late Stages of Lyme Disease

Late-stage (stage 3) infection occurs months after the original illness and typically consists of Lyme arthritis (joint swelling as opposed to muscle/joint pain, which is commonly seen in earlier stages of the illness).

When to Seek Medical Care

Speak with your healthcare provider if you think you've been bitten by a tick or exposed to one. It's important to seek emergency medical care if you notice a bulls-eye rash or experience any of the late signs of Lyme disease.

Lyme Disease and Facial Palsy

When Lyme disease affects the nerves in the face, it can result in facial drooping on one or both sides. This is referred to as Lyme neuroborreliosis (LNB) or neurological Lyme disease.

Facial drooping can accompany numbness, pain, weakness, impaired smiling and chewing, visual disturbances (double blinking or trouble blinking), and meningitis symptoms such as fever, stiff neck, and severe headache.

About 5% of children with Lyme disease will experience facial palsy.


Lyme disease is diagnosed based on clinical symptoms and exposure to ticks. Usually, the presence of a rash is enough to diagnose Lyme disease.

If a person does not have a rash, blood work that tests for antibodies (IgM and IgG) made by the body in response to infection might be checked. However, it can take time to make these antibodies, and they can last long after the disease is gone and treated.


Removing a tick quickly (within 24 hours) will significantly reduce your chances of getting Lyme disease. But if you have confirmed Lyme disease, the usual course of treatment will be antibiotics. The type of antibiotics and duration of treatment will depend on your age, your medical history, other existing medical conditions, and the associated symptoms.

Treatment for facial palsy can last up to 21 days or more. The earlier a person receives treatment, the better the outcome. Consult with your healthcare provider or an infectious disease specialist for treatment recommendations.


Early Lyme disease symptoms include a rash that can present differently in people but often looks like a bull's-eye. Later a person with Lyme disease may experience other symptoms, some of which can be neurological such as facial palsy. Early detection and treatment can help to cure and prevent further complications of Lyme disease. Contact your healthcare provider immediately if you have been exposed to a tick or have Lyme disease symptoms.

A Word From Verywell

If you plan to be outdoors in wooded or grassy areas, take preventive measures as best as possible. Cover exposed areas of skin with long sleeves, pants, high socks, and protective boots. Check common body parts where ticks may reside, including, under the arms, in and around the ears, inside the belly button, behind the knees, around the hairline, between your legs, and around the waist. Contact your healthcare provider immediately if you suspect a tick has bitten you.

Frequently Asked Questions

  • How common is bilateral facial palsy as a symptom of Lyme disease?

    Facial palsy occurs in about 5% of children with Lyme disease. Out of every 100 cases of Lyme disease reported, about 9 will include facial palsy. However, these numbers may be overestimated.

  • Can Lyme disease cause face tingling?

    Lyme disease that has affected the peripheral nerves may cause numbness and tingling in the arms and legs. In addition, when specific cranial nerves are affected, facial numbness may occur.

  • Can Lyme disease go away on its own?

    Treatment for Lyme disease will depend on the person and their symptoms. If left untreated, Lyme disease can spread to other body parts. While some say it can go away on its own, it is not recommended to forgo medical treatment.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Center for Disease Control and Prevention. Lyme disease: Data and surveillance.

  2. Center for Disease Control and Prevention. Lyme disease rashes and look a-likes.

  3. Center for Disease Control and Prevention. Signs and symptoms of untreated lyme disease.

  4. Krause P, Bockenstedt L. Lyme disease and the heartCirculation. 2013;127(7). doi:10.1161/circulationaha.112.101485

  5. Center for Disease Control and Prevention. Neurologic lyme disease.

  6. Esposito S, Bosis S, Sabatini C, Tagliaferri L, Principi N. Borrelia burgdorferi infection and Lyme disease in children. International Journal of Infectious Diseases. 2013;17I(3): e153-e158. doi:10.1016/j.ijid.2012.09.014

  7. MedlinePlus Lyme disease.

By Barbie Cervoni MS, RD, CDCES, CDN
Barbie Cervoni MS, RD, CDCES, CDN, is a New York-based registered dietitian and certified diabetes care and education specialist.