Chronic Neurological Lyme Disease or Comorbid Conditions After Treatment?
Chronic neurological Lyme disease symptoms may persist years after treatment.
Fatigue, pain, dizziness, and cognitive problems are commonly reported.
Distinguishing persistent neurologic symptoms from comorbid illness remains challenging.
The study, “Patient-reported outcome after treatment for definite Lyme neuroborreliosis” by Eikeland and colleagues, described 258 patients treated for definite neurologic Lyme disease.
Many patients with chronic neurological Lyme disease remained symptomatic an average of 5 years after their initial treatment.
According to the authors, a higher proportion of neuroborreliosis-treated patients reported severe fatigue. Mental health-related quality of life scores were also poorer compared with normative data.
Although many symptoms overlapped with those commonly described in chronic neurological Lyme disease, the investigators attributed symptoms to comorbid illnesses based on retrospective review of the medical records.
The study highlights an ongoing challenge in Lyme disease care — determining whether persistent neurologic symptoms represent ongoing complications of infection, residual injury, immune dysfunction, autonomic dysfunction, or unrelated comorbid disease.
For additional discussion of neurologic complications, see Six cases of neuroinvasive Lyme disease.
Symptoms reported after neurologic Lyme disease
The patients reported a broad range of persistent neurologic and systemic symptoms.
- Radiating pain
- Generalized pain
- Fatigue
- Facial palsy
- Malaise
- Dizziness or unsteadiness
- Headache
- Numbness in the arms or legs
- Memory and concentration problems
- Paresis in the arms or legs
- Diplopia
Many of these symptoms overlap with those described in persistent neurologic Lyme disease presentations.
Comorbid conditions complicating diagnosis
The authors identified multiple comorbid diagnoses in the patients’ medical records.
- Fibromyalgia
- Depression or anxiety
- Multiple sclerosis
- Sarcoidosis
- Systemic lupus erythematosus
- Sjögren syndrome
- Rheumatoid arthritis
- Chronic fatigue syndrome
- Parkinson disease
- Thyroid dysfunction
- Cancer
However, the study was not designed to determine whether these diagnoses represented true independent comorbidities or manifestations related to chronic neurological Lyme disease itself.
This distinction remains clinically important because neurologic Lyme disease may involve overlapping inflammatory, autoimmune, autonomic, and neurocognitive symptom patterns.
For related discussion, see autonomic dysfunction in Lyme disease.
Why persistent neurologic symptoms remain controversial
Persistent neurologic symptoms after Lyme disease continue to generate debate.
Some clinicians attribute ongoing symptoms primarily to unrelated conditions or residual injury after infection. Others argue that persistent immune activation, neuroinflammation, autonomic dysfunction, or ongoing infection may contribute in selected patients.
The challenge is compounded because symptoms such as fatigue, dizziness, pain, cognitive dysfunction, and sensory abnormalities overlap with multiple neurologic and systemic illnesses.
Advanced imaging studies and clinical research have continued to identify objective neurologic abnormalities in some patients with persistent Lyme-related symptoms.
For related neurologic findings, see neurological damage and dysfunction in early Lyme disease.
Frequently Asked Questions
What is chronic neurological Lyme disease?
Chronic neurological Lyme disease refers to persistent neurologic symptoms that continue after Lyme disease treatment, including fatigue, pain, cognitive dysfunction, dizziness, and neuropathic symptoms.
Can neurologic Lyme disease symptoms persist after treatment?
Yes. Some patients report ongoing neurologic symptoms for months or years after initial treatment.
What symptoms are associated with neurologic Lyme disease?
Symptoms may include fatigue, headaches, numbness, dizziness, cognitive problems, facial palsy, pain, and balance difficulties.
Are persistent symptoms caused by comorbid conditions?
Some studies attribute persistent symptoms to comorbid illnesses, while others suggest ongoing neuroinflammation, autonomic dysfunction, immune activation, or infection-related complications may contribute.
Can neurologic Lyme disease affect memory and concentration?
Yes. Memory impairment, slowed processing, and concentration problems are commonly reported in patients with persistent neurologic Lyme disease symptoms.
Clinical Takeaway
Patients treated for neurologic Lyme disease may continue experiencing fatigue, cognitive dysfunction, pain, dizziness, and sensory symptoms years after treatment.
Distinguishing chronic neurological Lyme disease manifestations from overlapping comorbid illnesses remains clinically challenging, particularly when symptoms involve multiple neurologic and systemic pathways.
Persistent neurologic symptoms after Lyme disease warrant careful clinical evaluation rather than premature dismissal as unrelated disease alone.
Related Articles
These related articles explore neurologic complications, persistent symptoms, and overlapping diagnostic challenges associated with chronic neurological Lyme disease.
Neurologic Lyme disease
Fatal case of neuroborreliosis
Persistent Lyme disease
Post-treatment Lyme disease syndrome
Lyme disease misdiagnosis
References
- Eikeland R, Ljøstad U, Helgeland G, et al. Patient-reported outcome after treatment for definite Lyme neuroborreliosis. Brain Behav. 2020;10(4):e01595.
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
How likely is that the persisting symptoms are due to persistent borrelial infection of the brain?
Researchers are still working on the mechanism for neurologic Lyme disease.
My sister was diagnosed with chronic Lyme 1.5 years ago. She has developed a mold toxicity and heavy metal toxicity at the same time and is being told she has the moldy gene that effects her ability to chelate on her own. Have you heard of this combination of illnesses previously with chronic Lyme disease?
I have individuals with Lyme disease and tick borne illnesses who have been advised that their illness in related to Mold. I have found that treating these individuals for a tick borne infection first rather than a mold approach has been helpful.
Hello Dr Cameron.
I have been ill since 2015 which was diagnosed as lyme and babesia Duncani on tests. I did pulsed abx up until 2018 and recovered 50%. I was told the remaining symptoms was residual damage.
Then in 2020, my turbinates enlarged (and have been ever since), my gp prescribed clarithromycin and 2 days after finishing the course something major happened to me. I lost peripheral vision, went confused, shaking and like my body was in shock. Later in hospital I developed a major migraine behind my eye, vomiting. Subsequently lost my ability to talk, words were slurred and jumbled and I couldn’t make sense of what docs were saying. I couldn’t read or write.
All MRI/CT was normal, and LP was also normal. They put me on IV ceft for two days and I eventually started feeling better although it took me some time to read again, it was so odd and never experienced anything like it.
They discharged me with migraine which I know is false. When I got home I began detiorating again and began reacting to antibiotics which I never did before 2020. I had siesure like episodes which happened around evening time every day where my limbs would become heavy and speech slurred. This gradually improved with abx. I also got a crohns diagnosis shortly after.
I’ve been fighting to stay alive ever since. So many symptoms and I can’t seem to get better. Every time I come off abx after 4 days my skin burns and siesure like things gradually come back. Abx seem to control only this but won’t get me better. My neurological symptoms are so bad.
I’ve tried searching for an LLMD that can help in complex cases. Is this something you think you could help with?
Thanks
You are not alone. I am glad you have ruled out causes. I have had patients where they respond to treatment even if they did not resolve their illness with IV ceftriaxone. I have found retreatment for Babesia duncani helpful.