Serum and cerebrospinal fluid examinations in the diagnosis of Borrelia infection in Bell's palsy.

Seventy-two consecutive patients with Bell's palsy were investigated for evidence of tick-borne Borrelia infection and to compare the merits of serum and cerebrospinal fluid examinations in the diagnosis of Borrelia infection. Serum was taken in the acute and convalescent stages from 72 patients, and cerebrospinal fluid was obtained from 35 of these. An enzyme-linked immunosorbent assay (ELISA) was used to analyse serum and cerebrospinal fluid samples for IgG and IgM antibodies against the Borrelia spirochete. The serum of 8 (11%) of the 72 patients was positive for IgG or both for IgG and IgM. Only 1 of the 35 patients presented an elevated titre of IgG and IgM in the cerebrospinal fluid as well as elevated IgG and IgM titres in the serum. The results, even if limited, indicate that screening of serum is sufficient to exclude Borrelia infection in cases of uncomplicated isolated acute peripheral facial palsy.