Lyme disease triggers neuropathy in the legs

Man with neuropathy due to Lyme disease receiving physical therapy.

It is well-recognized that Lyme disease can cause neurologic symptoms, such as peripheral neuropathy when the infection goes untreated. Patients can experience muscle weakness and/or twitching, loss of sensation in parts of the body, numbness, tingling sensations, problems with balance and bladder control, and a feeling of dizziness or faintness. But now, new research indicates that femoral neuropathy may also be due to Lyme disease.

A case report by Lazaro and Butt, published in the International Medical Case Reports Journal, describes a 67-year-old patient with Lyme disease and femoral neuropathy.¹ This is believed to be the first reported case of isolated femoral neuropathy triggered by Lyme disease.

Femoral neuropathy, also referred to as femoral nerve dysfunction, involves a loss of movement or sensation in parts of the legs due to damage to the femoral nerve.

The patient, who lived in central New York, a region endemic for Lyme disease, developed a large erythema migrans (EM or bull’s-eye) rash on his chest, which lasted for 3 weeks, along with swelling of his left knee.

An IgG Western blot test for Lyme disease was positive, and he was treated with a 4-week course of doxycycline.

“Shortly after the completion of the doxycycline therapy, this patient began complaining of gait difficulties and frequent falls, as well as intermittent painful cramps in his right thigh.”

An electromyography (EMG) test, which measures muscle response or electrical activity when a nerve muscle is stimulated, indicated the patient had a femoral neuropathy.

READ MORE: Small fiber neuropathy in Lyme disease and COVID-19

“A year after the onset of the disease, and following an extensive course of physical therapy, this patient was able to return to his full-time work as an attendant in a local store,” writes Lazaro.

“We firmly believe that the femoral neuropathy and Lyme disease seen in this patient were causally related,” the authors conclude.

This patient’s femoral neuropathy could have developed into a multifocal neuropathy, which involves damage to 2 or more different nerve areas, if the antibiotic treatment had been delayed.

“… if not for a timely institution of antimicrobial therapy, [the femoral neuropathy] might have evolved into a more overt or disseminated infectious or parainfectious process, affecting both the peripheral and central nervous systems.”

The authors’ findings suggest that femoral neuropathy is “analogous to facial nerve palsy as a presenting symptom of Lyme disease without the overt involvement of other cranial or peripheral nerves.”

The list of peripheral neuromuscular segments affected in Lyme disease has grown to include the nerve cell bodies and their axons, all of the cranial nerves except the olfactory nerve, the nerve roots, the brachial and lumbosacral plexuses, and the peripheral nerves, either in isolation or as part of a multiple or diffuse neuropathic process.²-³

  1. Lazaro RP, Butt K. Femoral mononeuropathy in Lyme disease: a case report. Int Med Case Rep J. 31 July 2019, Pages 243-247.
  2. Halperin JJ. Lyme disease and the peripheral nervous system. Muscle Nerve. 2003;28:133–147.
  3. Logigian EL. Peripheral nervous system Lyme borreliosis. Semin Neurol. 1997;17:25–29.

20 Replies to "Lyme disease triggers neuropathy in the legs"

  • Maria
    10/31/2022 (9:19 pm)

    I have the same through all my body. So it’s not the first case..

    • Steve from Brisbane, Australia
      05/10/2023 (10:10 pm)

      What can I say but “me too”. I am now 65. I was bitten by a tick when I was 43. When I presented to my GP I had the bullseye rash on my leg and I was treated to two weeks of doxycycline. Needless to say I soon developed chronic Lyme Disease. When I developed numbness in the legs, loss of balance, and difficulty walking I went to a neurologist for an EMG. Diagnosis – Femoral Neuropathy. I was 47 and our Doctors at the time made no connection to Lyme Disease. My symptoms are now much worse and I now have severe Edema in both legs. A few years ago I was given intravenous antibiotic treatment in hospital but I fear that chronic Lyme Disease still prevails.

      • Dr. Daniel Cameron
        05/15/2023 (11:41 pm)

        There are so many causes of neuropathy. Lyme disease happens to be one of them. Logigian and colleagues described Lyme neuropathy in 1990.

      • Theresa
        10/05/2023 (3:34 pm)

        I first became sick in the nineties…I also was in my 40’s….I became very sick without a definitive cause and in 2010 was diagnosed with chronic lyme thru igG in California…had to quit working…had trouble physically and trouble with my memory…
        I’m not as bad now 2023 but each day is different some days I’m still bedridden and just take one day at a time.

  • Michele L Mullis
    10/31/2022 (3:42 pm)

    I was left with lyme arthritis for the rest of my life after taking antibiotics for 3 months straight, having already had gout, so now I can hardly walk, it’s in my hips,feet,knees, back, elbows, hands, every joint. I live in pain mostly from my bedroom. I currently am waiting for court with an SSI case. This has destroyed my life as it was. Drs all say just treat like regular arthritis, but I’m telling you it’s not regular arthritis. I feel horrible. And my legs just won’t work some days. It’s a feebleness, a weakness and pain..

    • T Allen
      10/31/2022 (8:43 pm)

      I agree it’s not like “regular” arthritis and the other symptoms of weakness make it even worse. The good news is that if you continue with treatments (it can take a couple years in worse cases) the arthritis will go away. It took me almost 4 years on herbs alone to recover but I am now in remission and without symptoms including arthritis. You can take herbs with antibiotics so find a good Lyme literate Dr as you don’t want to be on antibiotics any longer than necessary. is a good resource for anything you might want to know about treating tickborn diseases. Hope you find some relief soon, it’s a horrible disease.

      • Eric
        11/01/2022 (5:43 am)

        T Allen, I have it now and am so scared. I did 4 months of DOXY and I caught it very early, within a week, but had had nerve problems since my bite in May. I am off Doxy now but have trouble walking. I am taking banderol and samento…..could this be a herx or am I getting worse? So hard to tell……….need help.

        • Emilie
          11/01/2022 (6:57 am)

          I live in France and my lyme doc is baffled why they treat lyme with doxy because it does NOT go through the cell membrane to attack where the bacteria is living inside. This is why people are still sick afterward 🙁 Azythromysine does the job! I was so sick i could barely walk or think. Now i can go for walks and function “normally” with some fatigue of course.

          • George
            01/01/2024 (9:59 pm)

            Thank you I live in Poconos PA and was bitten 10 years ago by three ticks at same time. Started feeling tingling, twitching muscles for years. Have periferal neuropathy (idiopathic). I plan to go to talk to Dr Cameron as he is about 80-90 miles away.

    • Dr. Daniel Cameron
      11/01/2022 (9:22 am)

      I have some patients who have benefited from a change to a different antibiotic.

  • Margaret
    10/31/2022 (2:04 pm)

    I wonder if IVIg would have been a possible remedy for at least alleviation of neurological symptoms as the author noted the following:
    “One previous case report described the sural nerve from a patient with tertiary LD, and it showed axonal changes and the deposition of membrane attack complexes in the blood vessels of the perineurium and epineurium.20 The findings are intriguing, and they raise the possibility of an autoimmune response seen in various immune-mediated polyneuropathies. Since there is no demonstrable direct invasion of the peripheral nerves by the spirochete in LNB cases, an immune-mediated mechanism remains a viable underlying pathology in the pathogenesis of peripheral neuropathy in LD.”

    Dr. Cameron, have you had experience is using IVIg in Lyme patients?

    • Dr. Daniel Cameron
      11/01/2022 (9:20 am)

      I have some patients who have benefited from IVIG. They have typically had to work with neurologists familiar with IVIG. I advise my patients to look a second time for a persistent infection before rushing to IVIG.

  • Anne Kupillas
    10/31/2022 (11:03 am)

    I experienced so much neuropathy with my Lyme Disease. But I really believe more research is needed on the cause of all the facial issues, which are attributed to Lyme but I actually think they’re all from Bartonella.

    I was diagnosed with Lyme & Babesiosis.

    Treated my Babesia first and resolved it quickly. I realized which symptoms were actually from Babesia.

    Treated my Lyme took much longer to clear up the neuropathy & I’m left with crippling arthritis.

    But there were stubborn symptoms that remained -for which I got a diagnosis of Bartonella. That included the occipital headaches, sinus pain & congestion, pain behind my eyes (especially the left eye), jaw pain , as well as other symptoms outside the head, such as foot pain which is often misdiagnosed as Plantar Fascitis.

    Bartonella is very misunderstood, and I wish there were more studies that look at Lyme + Bart and dissect them. I think part of the problem is that the govt says they haven’t proved Bartonella can be transmitted by ticks. Although the evidence suggests strongly otherwise!

    • Maria
      10/31/2022 (9:20 pm)


  • Hillary Monsour
    10/31/2022 (10:44 am)

    This happened to my mom as well with Lyme Disease. Her femoral neuropathy was bilateral and mainly affected the sensory portion of the nerves. Did this person have bilateral or unilateral damage?

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