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Belman et al1 do not report whether the accepted confirmatory serologic test for Lyme disease, the serum immunoblot,2 was performed on their patients. It is well established that enzyme-linked immunosorbent assay (ELISA) methods for total antibodies to Borrelia burgdorferi have a high false-positive rate. No cerebrospinal fluid assay, other than culture for B burgdorferi or polymerase chain reaction (PCR) for B burgdorferi DNA, is accepted as specific. Thus, Lyme disease was not confirmed in their patients and several or all may have had idiopathic Bell palsy.
Sood SK. Facial Palsy in Lyme Disease. Arch Pediatr Adolesc Med. 1998;152(9):928-929. doi: