Can Lyme Disease Cause Seizures? Symptoms, Causes, and What to Know

Can Lyme disease cause seizures? Yes—when the infection affects the central nervous system, seizures can occur as a serious neurologic complication.

A 55-year-old man presented to the emergency department with sudden tonic-clonic (grand mal) seizures as the first sign of neuroborreliosis. His condition progressed rapidly, requiring intubation—but resolved completely after treatment with intravenous ceftriaxone.

This case highlights an important clinical point: Lyme disease can cause seizures when Borrelia burgdorferi invades the central nervous system.

Seizures in Lyme disease may reflect neurologic involvement, neuroinflammation, or direct infection—particularly when occurring alongside headache, fever, or confusion.

These presentations are part of neurologic Lyme disease, where infection affects the brain and nervous system.

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Seizures as the First Sign of Lyme Disease

In their article “Lyme neuroborreliosis: A case report,” Sayad and colleagues describe seizures as the first manifestation of Lyme disease in a 55-year-old man.

The patient was admitted with sudden onset tonic–clonic seizures, involving loss of consciousness and violent muscle contractions. His condition deteriorated rapidly, requiring intubation.

This presentation is uncommon—but clinically important.

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The Week Before Seizures Began

Symptoms began one week prior to hospitalization and included headache, low-grade fever, malaise, anorexia, and vomiting.

Four days later, he experienced his first seizure and was prescribed anti-seizure medication and antibiotics.

The progression was rapid:

mild headache and fever → first seizure within days → deterioration requiring emergency care

This timeline demonstrates how quickly neurologic Lyme disease can evolve from mild symptoms to life-threatening complications.

These evolving patterns are often missed early and may contribute to Lyme disease misdiagnosis.

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The Diagnostic Process

Routine laboratory testing was largely unremarkable. However, cerebrospinal fluid analysis showed aseptic meningitis with lymphocyte predominance.

Lyme disease testing revealed high titers of both IgM and IgG antibodies to Borrelia burgdorferi, confirming the diagnosis.

Diagnosis required clinical suspicion. Without considering Lyme disease, the underlying cause may have been missed.

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Complete Resolution With Antibiotics

The patient was treated with intravenous ceftriaxone and experienced complete resolution of seizures.

This is a critical distinction: the seizures were caused by infection—not permanent neurologic damage or primary epilepsy.

Once the infection was treated, the seizures stopped. Long-term anti-seizure medication was not required.

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Why Lyme Disease Causes Seizures

Lyme disease can lead to seizures through several mechanisms involving the central nervous system:

• Direct CNS infection: Spirochetes cross the blood-brain barrier and invade brain tissue
• Meningitis: Inflammation of the brain and spinal cord membranes
• Encephalitis: Brain inflammation disrupting neuronal activity
• Vasculitis: Inflammation of cerebral blood vessels
• Immune-mediated inflammation: Cytokine-driven disruption of normal brain function

When these processes affect seizure-regulating regions of the brain, seizures may occur.

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Seizure Symptoms in Lyme Disease

• Loss of consciousness or awareness
• Tonic-clonic movements
• Post-seizure confusion
• Headache or neurologic symptoms before onset
• Fatigue or cognitive changes after episodes

These symptoms may occur alongside broader Lyme disease symptoms, particularly when neurologic involvement is present.

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Clinical Perspective

This case highlights several key points.

First, seizures can be the initial manifestation of Lyme disease. This means new-onset seizures should prompt consideration of infectious causes—especially in endemic areas.

Second, progression can be rapid. Within one week, this patient developed life-threatening neurologic complications.

Third, treatment can be highly effective. When seizures are caused by infection, appropriate antibiotic therapy may lead to complete resolution.

Finally, diagnosis depends on clinical judgment. No single test confirms Lyme disease in all cases—history, symptoms, and laboratory findings must be considered together.

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Clinical Takeaway

Lyme disease can cause seizures when the central nervous system is involved.

Symptoms may progress rapidly, even without classic Lyme features.

Early recognition matters. Prompt treatment can lead to full recovery—even in severe neurologic presentations.

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Related Seizure Presentations in Lyme Disease

• Lyme disease seizures in children
• Case: Lyme disease triggering seizures in a young child
• Seizures and altered mental status after a tick bite

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Frequently Asked Questions

Can Lyme disease cause seizures in adults?

Yes. Lyme disease affecting the central nervous system can lead to seizures, including tonic-clonic seizures.

Do Lyme-related seizures resolve with treatment?

Yes. When seizures are caused by infection, treating the underlying Lyme disease can lead to full resolution.

What type of seizures does Lyme disease cause?

Lyme disease can cause various seizure types, including tonic-clonic seizures, depending on the affected brain regions.

How quickly can Lyme disease lead to seizures?

In some cases, progression can occur within days to weeks when neurologic Lyme disease develops rapidly.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention