Can Lyme disease cause seizures? Yes. A 55-year-old man presented to the emergency department with tonic-clonic (grand mal) seizures as the first manifestation of neuroborreliosis. His seizures began suddenly, progressed rapidly requiring intubation, and resolved completely after IV ceftriaxone treatment for Lyme disease. This case demonstrates that Lyme disease can cause seizures when spirochetes invade the central nervous system, and emphasizes why clinicians must consider neuroborreliosis in patients with new-onset seizures, especially when accompanied by headache, fever, and meningitis.

Seizures as First Sign of Lyme Disease

In their article “Lyme neuroborreliosis: A case report,” Sayad and colleagues demonstrate that Lyme disease can, in fact, cause seizures. “Here, we present a case of neuroborreliosis with seizures as the first manifestation in a 55-year-old man.”

The patient was admitted to the emergency department with a sudden onset of tonic–clonic seizures. (This type of seizure, also referred to as a grand mal seizure, involves a loss of consciousness and violent muscle contractions.) The patient’s condition rapidly deteriorated and he was intubated.

The Week Before Seizures Began

His initial symptoms began 1 week prior to his hospitalization and included a mild headache, low-grade fever, malaise, anorexia, and vomiting.

Four days before hospitalization, he had his first seizure and was prescribed an anti-convulsive medication and antibiotic.

The progression was rapid: mild headache and fever → first seizure four days later → deterioration requiring emergency intubation. This timeline shows how quickly neurologic Lyme disease can progress from mild systemic symptoms to life-threatening neurologic emergency.

The Diagnostic Process

Routine laboratory tests were normal, except for a positive Wright and 2-mercaptoethanol test. As a result, the man was tested for Lyme disease.

“Our patient was suspected of neuroborreliosis due to aseptic meningitis with lymphocyte dominance. Hence, we requested serum anti-Borrelia antibodies (IgM and IgG) tests, both positive in high titers,” the authors wrote.

“The results of the serologic tests indicated the presence of both IgG and IgM antibodies to Borrelia burgdorferi,” the authors wrote.

The cerebrospinal fluid showed aseptic meningitis with lymphocyte dominance — a classic finding in neuroborreliosis. Combined with high-titer antibodies to Borrelia, this confirmed the diagnosis.

Complete Resolution With Antibiotics

The patient was treated successfully with IV ceftriaxone for Lyme disease and had a complete resolution of his seizures.

This is critical: the seizures weren’t from permanent brain damage or primary epilepsy. They were caused by active infection. Once the infection was treated, the seizures stopped completely. No long-term anti-seizure medications were needed.

Authors’ Conclusions

• “Lyme neuroborreliosis can be difficult to diagnose unless it presents with typical symptoms and clinicians actively consider this diagnosis.”
• “It causes a wide range of neurological and psychiatric disorders.”
• “There is no gold standard test that can be relied upon for diagnosis.”
• “This illness can be successfully treated if treatment starts early with antibiotics.”

Why Lyme Disease Causes Seizures

Lyme disease causes seizures through central nervous system invasion by Borrelia spirochetes. Mechanisms include:

• Direct CNS infection: Spirochetes cross blood-brain barrier and invade brain tissue
• Meningitis: Inflammation of brain and spinal cord membranes
• Encephalitis: Brain inflammation affecting neuronal function
• Vasculitis: Inflammation of brain blood vessels causing ischemia
• Immune-mediated inflammation: Cytokines and inflammatory responses disrupt normal brain activity

When these processes affect areas of the brain responsible for seizure control, seizures can occur.

Clinical Perspective

This case highlights several important teaching points about Lyme-related seizures. First, seizures can be the presenting manifestation of neuroborreliosis — not a late complication but the first sign. This means new-onset seizures warrant consideration of infectious etiologies, particularly in endemic areas or with recent tick exposure.

Second, the progression was rapid. Within one week, the patient went from mild headache and fever to life-threatening seizures requiring intubation. This emphasizes the importance of early recognition and treatment of neurologic Lyme disease.

Third, the complete resolution with antibiotics proves the seizures were infection-driven, not from permanent brain damage. Patients with Lyme-related seizures don’t necessarily need long-term anti-seizure medications — they need treatment for the underlying infection.

Finally, the authors’ point about no “gold standard test” is important. Diagnosis requires clinical judgment combining exposure history, symptoms, serology, and CSF findings. No single test definitively proves or excludes neuroborreliosis.

Frequently Asked Questions

Can Lyme disease cause seizures in adults?

Yes. This 55-year-old man had tonic-clonic seizures as the first manifestation of neuroborreliosis. Seizures can occur in adults with Lyme disease affecting the central nervous system.

Do Lyme seizures resolve with treatment?

Yes. This patient had complete resolution of seizures after IV ceftriaxone treatment. When seizures are caused by active Lyme infection, treating the infection stops the seizures.

What type of seizures does Lyme disease cause?

Lyme disease can cause various seizure types. This case involved tonic-clonic (grand mal) seizures with loss of consciousness and violent muscle contractions. Other seizure types are also possible depending on which brain areas are affected.

How quickly can Lyme cause seizures?

This patient progressed from mild symptoms to life-threatening seizures within one week, showing neurologic Lyme can progress rapidly from early systemic symptoms to severe neurologic emergency.