Neurologic Lyme Disease in Children
Facial palsy and meningitis are among the most common pediatric neurologic manifestations of Lyme disease.
Children may not recall a tick bite or develop a rash.
Neurologic symptoms can appear weeks after infection.
Neurologic Lyme disease in children is one of the more serious manifestations of Lyme disease and may involve the brain, meninges, cranial nerves, spinal cord, or peripheral nerves. Symptoms may appear weeks to months after infection with Borrelia burgdorferi.
Neurologic involvement is relatively common in pediatric Lyme disease. In one pediatric series, approximately one-third of children meeting criteria for Lyme disease had neurologic manifestations, with facial palsy and aseptic meningitis accounting for most presentations.
Children with neurologic Lyme disease may not remember a tick bite and may never develop the classic erythema migrans rash. Because symptoms are often nonspecific, diagnosis may be delayed.
For more general information on pediatric presentations, see pediatric Lyme disease.
Common Neurologic Symptoms in Children
Neurologic Lyme disease in children can affect both the central and peripheral nervous systems.
- facial nerve palsy
- headache
- neck stiffness
- meningitis
- dizziness
- fatigue
- irritability
- poor concentration
- memory difficulties
- sleep disturbance
- balance problems
- limb weakness
- sensory symptoms
- mood changes
Small children may present differently than adults and can develop nonspecific symptoms such as appetite loss, behavioral changes, fatigue, or mood changes.
Facial Palsy and Cranial Nerve Involvement
Facial nerve palsy is among the most common neurologic manifestations of pediatric Lyme disease and may be the first sign recognized by parents or clinicians.
Studies have consistently identified facial palsy as the most common cranial neuropathy in children with Lyme disease. Facial weakness may occur without fever, rash, or other obvious Lyme symptoms.
Children may develop:
- unilateral facial weakness
- bilateral facial palsy
- difficulty closing one eye
- drooping mouth
- speech changes
- excess tearing
- difficulty eating or drinking
Because facial palsy has many causes, Lyme disease should remain in the differential diagnosis in endemic regions.
Lyme Meningitis in Children
Lyme meningitis is one of the most frequent neurologic manifestations in pediatric neuroborreliosis.
Children may develop:
- headache
- neck stiffness
- light sensitivity
- nausea
- vomiting
- fatigue
- irritability
Symptoms may evolve gradually and can be milder than bacterial meningitis, increasing the risk of delayed recognition.
Rarely, children with neurologic Lyme disease may develop increased intracranial pressure or pseudotumor cerebri-like syndromes causing headache, papilledema, or visual symptoms.
Less Common Neurologic Manifestations
Less common neurologic complications have also been reported.
- radiculopathy
- seizures
- cranial neuropathies beyond facial nerve involvement
- ataxia
- peripheral neuropathy
- encephalopathy
- intracranial hypertension
- rare cerebrovascular complications
Unlike adults, painful radiculitis appears less frequently in children.
Diagnosing Neurologic Lyme Disease in Children
Diagnosis relies on clinical presentation combined with exposure history, examination findings, and laboratory testing.
- tick exposure history
- neurologic examination
- Lyme serology
- cerebrospinal fluid testing in selected cases
- brain imaging when indicated
- evaluation for alternative diagnoses
Neurologic Lyme disease can be difficult to recognize because erythema migrans or arthritis may be absent. Earlier pediatric studies found many children with neurologic Lyme disease lacked classic Lyme features at presentation.
For additional information on testing limitations, see why Lyme tests medicine.
Conditions That Can Mimic Pediatric Neuroborreliosis
Several disorders may resemble neurologic Lyme disease.
- Bell’s palsy
- viral meningitis
- juvenile migraine syndromes
- multiple sclerosis
- functional neurologic disorders
- pseudotumor cerebri
- intracranial mass lesions
- autoimmune disease
- viral neuropathies
Treatment of Neurologic Lyme Disease in Children
Antibiotic treatment depends on symptom severity, age, neurologic involvement, and individual clinical circumstances.
Commonly used therapies may include:
- doxycycline
- amoxicillin
- cefuroxime
- ceftriaxone for selected cases
Most children improve with treatment, although recovery may take weeks to months depending on the neurologic manifestations.
For additional information on pediatric recovery, see recovery from Lyme disease.
Clinical Perspective
Neurologic Lyme disease in children often presents differently than adult disease. Facial palsy, headache, meningitis, or subtle cognitive changes may be the first clues. Because many children never recall a tick bite or rash, clinicians and families may not immediately suspect Lyme disease.
In endemic regions, unexplained neurologic symptoms—particularly facial palsy or meningitis—should prompt consideration of Lyme disease in the differential diagnosis.
FAQ
Can Lyme disease cause facial palsy in children?
Yes. Facial nerve palsy is one of the most common neurologic manifestations of pediatric Lyme disease.
Can children have neurologic Lyme disease without a rash?
Yes. Many children with neurologic involvement do not recall a rash or tick bite.
Is Lyme meningitis common in children?
Meningitis is among the more common neurologic presentations in pediatric neuroborreliosis and may present with headache, fatigue, and neck stiffness.
Can MRI diagnose neurologic Lyme disease?
MRI may help exclude other disorders but is not diagnostic for neurologic Lyme disease.
Do most children recover?
Most children improve substantially with treatment, although recovery time varies.
Clinical Takeaway
Neurologic Lyme disease in children frequently presents with facial palsy, meningitis, headache, or subtle neurologic symptoms rather than classic Lyme features. Early recognition remains important because many children lack a recalled tick bite or erythema migrans rash.
Related Articles
Learn more about pediatric Lyme disease, neurologic Lyme disease, Lyme disease seizures, and brain fog and Lyme disease.
References
- Bingham PM, Galetta SL, Athreya B, Sladky J. Neurologic manifestations in children with Lyme disease. Pediatrics. 1995;96(6):1053-1056.
- Belman AL, Iyer M, Coyle PK, Dattwyler R. Neurologic manifestations in children with North American Lyme disease. Neurology. 1993;43(12):2609.
- Kozak S, Kaminiów K, Kozak K, Paprocka J. Lyme Neuroborreliosis in Children. Brain Sci. 2021;11(6):758.
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
