Lyme Disease Seizures in Children: 4-Year-Old’s Story

Lyme disease seizures in children are rare but serious. Lyme disease seizures in children can occur when infection affects the brain and nervous system, triggering inflammation that disrupts normal neurologic function. A 4-year-old boy developed status epilepticus requiring intubation—no warning, no fever, no obvious cause. When seizures didn’t respond to standard medication, doctors searched for answers but took days to uncover the diagnosis: neuroborreliosis.

His case demonstrates that Lyme disease can present as life-threatening seizures in children without classic symptoms, and that behavioral and psychiatric symptoms can persist for months after antibiotic treatment. Neurologic complications like seizures represent one of the more severe patterns described in the broader Lyme disease symptoms guide.

The Case: A 4-Year-Old With Status Epilepticus

In a recent case report published by Khurtsilava and colleagues, researchers describe a 4-year-old boy admitted to a clinic in Tbilisi, Georgia after exhibiting generalized tonic-clonic seizures. One dose of diazepam didn’t stop them.

In the two days before admission, the child had developed increased fatigue, refused to walk, fell twice, and lost consciousness three times. The morning of his presentation, he woke up lethargic—then the seizures began.

Clinicians diagnosed status epilepticus and intubated him. They prescribed IV midazolam to control the seizures. But EEG testing revealed no epileptic patterns. No apparent cause could be identified.

The medical team prescribed ceftriaxone and acyclovir, but discontinued the antiviral after testing came back negative for herpes simplex virus. They were searching—but still hadn’t found the answer.

When Lyme Disease Was Finally Considered

Lyme disease seizures in children are not a classic presentation. Nervous system Lyme disease more commonly causes facial nerve palsy or subacute meningitis in pediatric patients. Seizures are rarely reported.

Seizures are an uncommon manifestation of neurologic Lyme disease. More typical pediatric neurologic presentations include facial nerve palsy, meningitis with headache and neck stiffness, and cognitive or behavioral changes. However, when infection affects the central nervous system, inflammation can occasionally provoke seizures.

But the medical team didn’t stop looking. “Despite non-classical manifestations, Lyme disease was considered,” the authors state. The child tested positive. Treatment with doxycycline began.

Only then did his parents recall something important: four months earlier, they had noticed a rash on their son. It had resolved on its own. No one connected it to his current crisis.

This is how Lyme disease misdiagnosis in children happens. Most children with Lyme never recall a tick bite. Rashes fade. Symptoms appear months later in forms that don’t look like the textbook.

Post-Treatment: The Symptoms Didn’t End There

One month after treatment, the child exhibited mood changes and sleep disorders with night terrors. His mother reported the presence of imaginary friends and anxiety.

Four months after the initial diagnosis, severe behavioral problems persisted—frequent tantrums, screaming, and hallucinations. The child received psychiatric care. These symptoms gradually resolved after six months, with only mild mood swings still present.

This pattern—neurological symptoms followed by prolonged behavioral and cognitive issues—raises important questions about the long-term effects of neuroborreliosis in children and underscores why managing Lyme in children requires more than antibiotics alone.

What This Case Teaches Us

The authors draw several important conclusions from this case of Lyme disease seizures in children.

First, Lyme borreliosis belongs in the differential diagnosis when complex neurological symptoms arise in pediatric patients—even when the presentation is atypical. Seizures aren’t what most clinicians expect from Lyme, which is precisely why they get missed.

Second, awareness of uncommon clinical manifestations is crucial for successful diagnosis and treatment. If the medical team hadn’t considered Lyme despite the unusual presentation, the underlying infection might have remained undiagnosed.

Third, the prolonged post-treatment behavioral problems raise questions about potential long-term effects of neuroborreliosis. This case shows the need for continued research into a comprehensive understanding of Lyme disease in pediatric patients—and the importance of long-term follow-up during recovery.

Frequently Asked Questions

Can Lyme disease cause seizures in children?

Yes, though it’s rare. Lyme disease seizures in children have been documented in case reports. When a child presents with unexplained seizures and no clear cause is found, Lyme disease should be considered—especially in endemic areas or with possible tick exposure.

Why are Lyme disease seizures in children often missed?

Because seizures aren’t a classic Lyme symptom. Clinicians typically expect rash, joint pain, or facial palsy. When symptoms don’t fit the textbook, Lyme drops off the radar—even when it’s the underlying cause.

Can Lyme disease cause status epilepticus?

In rare cases, Lyme disease affecting the nervous system (neuroborreliosis) can provoke severe seizures, including status epilepticus. Prompt recognition and antibiotic treatment are essential.

What should I do if my child had seizures and no cause was found?

Ask about Lyme disease testing. Be aware that standard tests have limitations and may miss early or neurological Lyme. A clinical evaluation by a physician experienced in tick-borne illness may be warranted.

Can children have lasting symptoms after Lyme treatment?

Yes. As this case shows, behavioral and cognitive symptoms can persist for months after treatment. In this case, hallucinations, tantrums, and night terrors continued for six months after antibiotics. Comprehensive care and long-term follow-up are essential for supporting full recovery.

What are typical neurologic Lyme symptoms in children?

Facial nerve palsy (facial weakness or drooping) is most common. Meningitis with headache and neck stiffness occurs in some cases. Seizures, as in this case, are rare but documented. Cognitive symptoms and behavioral changes can also occur.

Clinical Takeaway

This case highlights several critical issues in pediatric neuroborreliosis. The diagnostic delay is striking—the child had a rash four months before seizures began, but the connection wasn’t made until after hospitalization. The severity of presentation was extreme: status epilepticus requiring intubation. When Lyme affects the central nervous system in children, it can progress rapidly to life-threatening complications. Critically, the EEG showed no epileptic patterns—these weren’t primary epileptic seizures but infection-driven seizures that stopped once the infection was treated.

The prolonged behavioral and psychiatric symptoms post-treatment are deeply concerning. Hallucinations, tantrums, night terrors, imaginary friends—these persisted for six months after antibiotics. This suggests either incomplete resolution of central nervous system inflammation, or that Lyme-induced neurologic injury and inflammation can take months to heal even after spirochetes are killed. If the medical team had stopped at “EEG is normal, not epilepsy, we don’t know the cause,” this child would never have been diagnosed or treated. Their willingness to consider Lyme “despite non-classical manifestations” ultimately led to diagnosis and treatment.