Can Lyme Disease Cause Seizures?
Seizures are a rare manifestation of Lyme neuroborreliosis
Cases have been reported in both children and adults
Unexplained seizures may warrant evaluation for tick-borne disease
Lyme disease seizures are uncommon, but rare case reports describe seizures occurring in patients with nervous system Lyme disease. Neurologic Lyme disease more often presents with facial nerve palsy, meningitis, radiculoneuritis, headache, pain, cognitive changes, or sensory symptoms. However, seizures have been reported in both children and adults when Lyme disease affects the nervous system.
Most patients with Lyme neuroborreliosis develop more typical neurologic manifestations such as facial nerve palsy, meningitis, radicular pain, or cognitive symptoms rather than seizures.
Nervous system Lyme disease has a wide spectrum of manifestations, including facial nerve palsy and subacute meningitis, which are often observed in the pediatric population. But only rarely have cases of seizures associated with Lyme disease been reported.
In their case report, Khurtsilava and colleagues describe a 4-year-old boy who was admitted to a clinic in Tbilisi, Georgia after exhibiting generalized tonic-clonic seizures that did not improve with one dose of diazepam therapy.
During the previous 2 days, the child developed increased fatigue, refused to walk, had two instances of falling, and lost consciousness three times.
“The morning of the presentation, the child woke up feeling lethargic, followed by tonic-clonic seizures, and loss of awareness.”
Clinicians diagnosed the child with status epilepticus. He was subsequently intubated and prescribed IV midazolam.
However, EEG testing later revealed no epileptic patterns, and no apparent cause was initially identified for the seizures.
The antibiotic ceftriaxone was prescribed, along with acyclovir, which was discontinued after test results were negative for herpes simplex virus.
Could Lyme disease trigger seizures in the young child?
“Despite non-classical manifestations, Lyme disease was considered,” the authors state. Subsequently, the child tested positive for Lyme disease and began treatment with doxycycline.
“Upon discussing the results with the parents, they recalled noticing a rash four months ago, which resolved on its own,” the authors state.
One month after treatment, the child exhibited mood changes and sleep disorders with night terrors.
“The mother reported the presence of imaginary friends and anxiety,” the authors state.
Four months after the initial diagnosis, severe behavioral problems persisted, including frequent tantrums, screaming, and hallucinations.
The child received psychiatric care, and these symptoms gradually resolved after six months, with only mild mood swings still present.
How can Lyme disease lead to seizures?
Seizures are not considered a common symptom of Lyme disease. When they occur, they are typically discussed in the setting of central nervous system involvement, such as Lyme neuroborreliosis, meningitis, encephalitis, encephalomyelitis, or immune-mediated neurologic inflammation.
Proposed mechanisms include inflammation of the central nervous system, encephalitis, meningeal involvement, and, in selected patients, infection-associated immune dysregulation. However, these mechanisms remain incompletely understood.
A 2023 review of neurologic Lyme disease notes that neurologic manifestations may include facial nerve palsy, aseptic meningitis, painful radiculoneuritis, encephalomyelitis, and other inflammatory neurologic syndromes. These neurologic features help explain why Lyme disease may be considered in selected patients with unexplained neurologic symptoms, especially when there is tick exposure or a history of erythema migrans rash.
A 2025 systematic review and meta-analysis found that neurologic complications are recognized in Lyme disease patients, although the specific manifestations vary widely across studies. Lyme neuroborreliosis seizures remain uncommon and are best supported by case reports rather than large controlled studies.
Can Lyme disease cause epilepsy?
Lyme disease is not considered a common cause of epilepsy. However, rare reports describe seizures or treatment-refractory epilepsy developing in temporal association with Lyme-associated illness. These reports do not establish that Lyme disease causes epilepsy but suggest that infection-associated neuroinflammation or immune dysregulation may contribute in selected patients.
In a 2026 report, Cipriano described two patients with treatment-refractory seizures that developed in temporal association with Lyme-associated illness and antimicrobial therapy. The authors emphasized that the findings do not establish a causal relationship between Lyme disease and autoimmune epilepsy, but they raise the possibility that infection-associated immune dysregulation may contribute to seizure activity in selected patients.
Another case report described tremor, seizures, and psychosis as presenting symptoms in a patient with chronic Lyme neuroborreliosis. The patient improved after treatment with intravenous ceftriaxone and doxycycline, although neurologic sequelae persisted during the post-treatment period.
Authors conclude
- “We believe that this case underscores the importance of considering Lyme borreliosis in the differential diagnosis when complex neurological symptoms arise in pediatric patients.”
- “The awareness of uncommon clinical manifestations in pediatric patients with Lyme neuroborreliosis is crucial for clinicians to successfully diagnose and treat the disease.”
- “The prolonged post-treatment behavioral problems raise questions about the potential long-term effects of neuroborreliosis and show the need for continued research into a comprehensive understanding of Lyme disease in pediatric patients.”
Frequently Asked Questions
Can Lyme disease cause seizures?
Yes, but seizures are uncommon in Lyme disease. Rare pediatric and adult case reports describe seizures occurring in association with Lyme neuroborreliosis or Lyme-associated immune dysregulation.
Are seizures a common symptom of Lyme disease?
No. The more common neurologic signs of Lyme disease include facial nerve palsy, meningitis, radicular pain, headache, numbness, cognitive changes, and fatigue. Seizures are considered rare.
Can a tick bite cause seizures?
A tick bite itself does not usually cause seizures. However, infections transmitted by ticks, including Lyme disease and other tick-borne infections, may occasionally involve the nervous system and should be considered when seizures occur with compatible exposure history or other neurologic symptoms.
Can Lyme disease cause epilepsy?
Lyme disease is not considered a common cause of epilepsy. Rare reports describe seizures or treatment-refractory epilepsy occurring in temporal association with Lyme-associated illness, but the evidence remains limited and does not prove causation.
Should Lyme disease be considered in someone with unexplained seizures?
Lyme disease may be considered when seizures occur with a history of tick exposure, erythema migrans rash, facial palsy, meningitis symptoms, radicular pain, cognitive changes, psychiatric symptoms, or residence in or travel to a Lyme-endemic region.
Clinical Takeaway
Lyme disease seizures are rare, but they have been reported in patients with Lyme neuroborreliosis and in cases involving possible infection-associated immune dysregulation.
Clinicians evaluating unexplained seizures—particularly in children or adults with tick exposure, rash history, facial palsy, meningitis symptoms, radicular pain, cognitive changes, or psychiatric symptoms—should consider Lyme disease and other tick-borne infections in the differential diagnosis.
Seizures should not be viewed as a typical Lyme disease symptom, but rare cases show that nervous system Lyme disease can present in unexpected ways.
Related Articles
These related articles discuss neurologic Lyme disease, seizures, psychiatric symptoms, and pediatric presentations.
Seizures and altered mental status after Lyme disease
Brain inflammation and Lyme disease
Lyme disease symptoms guide
Neuropsychiatric Lyme disease
Pediatric Lyme disease
References
- Govil S, Capitle E, Lacqua A, Khianey R, Coyle PK, Schutzer SE. Common neurologic features of Lyme disease that may present to a rheumatologist. Pathogens. 2023;12(4):576. doi:10.3390/pathogens12040576
- Khurtsilava I, Kanjaradze D, Tsirdava N, et al. Rare presentation of pediatric nervous system Lyme disease: A case report. Cureus. 2024;16(5):e60535. doi:10.7759/cureus.60535
- Cipriano PM. Autoimmune epilepsy temporally associated with Lyme disease: A report of two cases. Cureus. 2026;18(3):e105228. doi:10.7759/cureus.105228
- Markeljević J, Sarac H, Rados M. Tremor, seizures and psychosis as presenting symptoms in a patient with chronic Lyme neuroborreliosis. Coll Antropol. 2011;35 Suppl 1:313-318.
- Bushi G, Balaraman AK, Gaidhane S, et al. Lyme disease associated neurological and musculoskeletal symptoms: A systematic review and meta-analysis. Brain Behav Immun Health. 2025;43:100931. doi:10.1016/j.bbih.2024.100931
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
