Can Lyme Disease Cause Seizures? Symptoms, Causes, and What to Know
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 in Lyme disease may reflect neurologic involvement, neuroinflammation, or central nervous system infection, particularly when occurring alongside symptoms such as headache, fever, or confusion.
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.
Why Lyme Disease Causes Seizures
Lyme disease causes seizures through central nervous system invasion by Borrelia spirochetes. Mechanisms include:
- Direct CNS infection: Spirochetes cross the 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.
Seizure Symptoms in Lyme Disease
- Loss of consciousness or awareness
- Tonic-clonic (grand mal) movements
- Confusion or disorientation after seizures
- Headache or neurologic symptoms before onset
- Fatigue or cognitive changes following episodes
These symptoms may occur as part of a broader pattern of Lyme disease symptoms, especially when neurologic involvement is present.
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, diagnosis requires clinical judgment. There is no single “gold standard” test. Clinicians must integrate exposure history, symptom patterns, serology, and cerebrospinal fluid findings.
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
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, as demonstrated in this case.
Do Lyme seizures resolve with treatment?
Yes. When seizures are caused by active Lyme infection, treating the infection can lead to full resolution.
What type of seizures does Lyme disease cause?
Lyme disease can cause various seizure types, including tonic-clonic seizures. The presentation depends on which areas of the brain are affected.
How quickly can Lyme cause seizures?
In some cases, progression can occur within days to weeks, especially when neurologic Lyme disease develops rapidly.
Related Reading:
References:
- Sayad B, Babazadeh A, Barary M, Hosseinzadeh R, Ebrahimpour S, Afshar ZM. Lyme neuroborreliosis: A case report. Clin Case Rep. 2023 Aug 7;11(8):e7702.
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.