Can Lyme Disease Cause Seizures? Symptoms, Causes, and What to Know
Can Lyme disease cause seizures? Yes. When Borrelia burgdorferi infects the central nervous system, seizures can occur — and in some cases, they may be the first sign of neurologic involvement.
A 55-year-old man presented to the emergency department with sudden tonic-clonic seizures as the first manifestation of Lyme neuroborreliosis. His condition progressed rapidly, requiring intubation — but resolved completely after treatment with intravenous ceftriaxone.
These presentations are part of neurologic Lyme disease, where infection affects the brain and nervous system in ways that may not initially suggest Lyme disease as the cause.
Seizures as the First Sign of Lyme Disease
Sayad and colleagues describe a case of neuroborreliosis in which seizures were the first manifestation 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. It illustrates that Lyme disease does not always begin with a rash or joint pain — neurologic involvement can appear first and progress quickly.
How Symptoms Progressed
Initial symptoms began one week before hospitalization and included mild headache, low-grade fever, malaise, loss of appetite, and vomiting. Four days before hospitalization, he experienced his first seizure and was prescribed anti-seizure medication and antibiotics.
Within days, his condition deteriorated to the point of requiring emergency intubation. The rapid escalation from mild prodromal symptoms to life-threatening neurologic complications illustrates how quickly Lyme neuroborreliosis can evolve.
These evolving patterns are often missed early and may contribute to Lyme disease misdiagnosis when neurologic symptoms are attributed to other causes.
The Diagnostic Process
Routine laboratory testing was largely unremarkable. However, cerebrospinal fluid analysis showed aseptic meningitis with lymphocyte predominance — a finding that prompted Lyme disease testing.
Serum testing revealed high titers of both IgM and IgG antibodies to Borrelia burgdorferi, confirming neuroborreliosis. Without clinical suspicion prompting that testing, the underlying cause may have been missed entirely.
The authors note that Lyme neuroborreliosis can be difficult to diagnose unless clinicians actively consider it — there is no single gold standard test that can be relied upon for diagnosis in all cases.
Complete Resolution With Antibiotic Treatment
The patient was treated with intravenous ceftriaxone and experienced complete resolution of seizures. The seizures were caused by infection — not permanent neurologic damage or primary epilepsy. Once the infection was treated, the seizures stopped and long-term anti-seizure medication was not required.
The authors conclude that Lyme neuroborreliosis can be successfully treated when treatment begins early with appropriate antibiotics.
Why Lyme Disease Can Cause Seizures
Lyme disease can lead to seizures through several mechanisms involving the central nervous system. Spirochetes may cross the blood-brain barrier and invade brain tissue directly. Meningitis — inflammation of the membranes surrounding the brain and spinal cord — can disrupt neuronal activity. Encephalitis, vasculitis affecting cerebral blood vessels, and cytokine-driven immune-mediated inflammation may all contribute to seizure threshold changes.
When these processes affect seizure-regulating regions of the brain, seizures may occur — sometimes as the earliest and most dramatic sign of infection.
These mechanisms overlap with broader patterns described in Lyme disease symptoms and reflect the wide range of neurologic complications Lyme disease can produce.
Seizure Symptoms in Lyme Disease
Lyme-related seizures may include loss of consciousness or awareness, tonic-clonic movements, post-seizure confusion, headache or neurologic symptoms before onset, and fatigue or cognitive changes after episodes. These symptoms may occur alongside broader neurologic involvement — particularly when infection has reached the central nervous system.
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 — even in adults with no prior seizure history.
Do Lyme-related seizures resolve with treatment?
Yes. When seizures are caused by Lyme infection, treating the underlying disease with appropriate antibiotics can lead to full resolution. In this case, the patient did not require long-term anti-seizure medication after antibiotic treatment.
What type of seizures does Lyme disease cause?
Lyme disease can cause various seizure types depending on which brain regions are affected. Tonic-clonic seizures — involving loss of consciousness and muscle contractions — have been documented as a presenting feature of Lyme neuroborreliosis.
How quickly can Lyme disease lead to seizures?
In some cases, progression can occur within days to weeks. In this case, the patient developed tonic-clonic seizures within four days of initial prodromal symptoms and required intubation within a week of first becoming ill.
Can seizures be the first sign of Lyme disease?
Yes. This case documents seizures as the first manifestation of neuroborreliosis — before any classic Lyme features such as rash or joint pain were present. New-onset seizures should prompt consideration of infectious causes, particularly in endemic areas.
Clinical Takeaway
Lyme disease can cause seizures when the central nervous system is involved — and in some cases, seizures may be the first and most dramatic sign of infection. Progression can be rapid, moving from mild prodromal symptoms to life-threatening neurologic complications within days. Diagnosis requires active clinical suspicion, as routine testing may be unremarkable and no single test confirms the diagnosis in all cases.
The authors note that Lyme neuroborreliosis causes a wide range of neurologic and psychiatric disorders, and that early treatment with antibiotics can lead to successful outcomes.
New-onset seizures — particularly in patients with possible tick exposure or other Lyme symptoms — should prompt evaluation for neurologic Lyme disease before attributing the cause to primary epilepsy.
Related Articles
- Neurologic Lyme Disease: When Infection Affects the Brain
- Lyme Disease Seizures in Children
- Seizures and Altered Mental Status After a Tick Bite
- Lyme Disease Misdiagnosis
- Brain Fog in Lyme Disease
References
- Sayad B, Babazadeh A, Barary M, Hosseinzadeh R, Ebrahimpour S, Afshar ZM. Lyme neuroborreliosis: a case report. Clin Case Rep. 2023;11(8):e7702. doi:10.1002/ccr3.7702. PMID: 37554577.
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
It’s amazing to me how ignorant most of the medical community is regarding Chronic Lyme. I was turned away from every major infectious disease department, ie: U of P, Yale, Jefferson University, Harvard, etc. All said, “We do not diagnose nor treat Lyme” AND, you have to prove that you have it. Antibiotics won’t cure it once it leaves the bloodstream. The suffering of men, women, and children once it is chronic is past malpractice. We had the same issue 35 years ago with Chronic Fatigue syndrome. Then they discovered the Epstein Barr virus and it became a “real” disease”. Tens of thousands suffered. So, 13 years later and now dealing with Lyme Carditis, and coinfections, ie, Babasia, Bartonella, to name a few I have sought homeopathic sources that can get to the nervous system, break down biofilm and exosomes for reduction of brain inflammation. Sadly, the cost is extreme however, it is better than the alternative. Pfizer had a vaccine in the early 2000’s that worked. They were sued over a reaction by someone and removed it from the market. People now need to understand its not just deer ticks or ticks in general.
I am suffering so much I don’t know what to do. I don’t know what happened but it seems like Covid has caused something worse to happen to me. I was already suffering seizures after contacting a tick borne illness. It took months for a diagnosis which wreaked havoc on my body.
i know someone with meningitis, she was a search & rescue dog person; plus i recieve lymetyme. newsletter i also experience low grade fever seems like its my lifestyle ,spasms, so much inflammation, lacking & slow lymph node problem, how can i participate with access to antigen urine tests.
my Son got a series of 3 shots for the vaccine for Lyme disease as a prevention since he was an avid hunter and fisherman back in 1999 when he was 12 years old. He started to have severe seizures in 2011 from unknown causes then died a year later at the age of 25 from a seizure. I wonder if the Lyme Vaccine caused the seizures?
I had not had a patient with seizures. The vaccine was pulled from the market before we had the opportunity to understand it.