Neurologic Lyme Disease in Children
Facial palsy may be a sign of neurologic Lyme disease.
Children can also develop meningitis, headaches, dizziness, or fatigue.
Early neurologic examinations may sometimes appear normal.
Neurologic Lyme disease in children occurs when Lyme disease affects the nervous system. This condition is often referred to as Lyme neuroborreliosis.
Children with neurologic Lyme disease may develop facial nerve palsy, meningitis, headaches, dizziness, fatigue, or other neurologic symptoms. Some children present with more subtle problems such as mood changes, irritability, difficulty concentrating, or behavioral symptoms.
Because these symptoms may appear gradually and are not always specific, the diagnosis can sometimes be delayed.
Common Neurologic Symptoms of Lyme Disease
Children with Lyme neuroborreliosis most often present with cranial nerve involvement or meningitis.
Common neurologic Lyme disease symptoms include:
- facial nerve palsy (Bell’s palsy)
- headaches
- neck stiffness
- fatigue
- dizziness
- difficulty concentrating
- mood changes or irritability
- loss of appetite
Some children develop diffuse neurologic symptoms that overlap with viral illness, migraine, anxiety, or other childhood conditions.
Facial Palsy and Cranial Nerve Involvement
Facial nerve palsy is one of the most recognized neurologic manifestations of Lyme disease in children.
The weakness is usually seen on one side of the face but may occasionally affect both sides.
Other cranial nerves may also be involved, including the trigeminal nerve, abducens nerve, or trochlear nerve.
In endemic areas, Lyme disease should remain part of the differential diagnosis when children present with sudden facial weakness.
Lyme Meningitis in Children
Lyme meningitis occurs when the infection affects the membranes surrounding the brain and spinal cord.
Symptoms may include:
- headache
- neck stiffness
- fatigue
- light sensitivity
- nausea
Unlike severe bacterial meningitis, Lyme meningitis in children may present more gradually and can initially resemble a viral illness.
In endemic regions, Lyme disease has been identified as one of the more common causes of meningitis in children between the ages of five and nine.
Behavioral, Neuropsychiatric, and Autonomic Symptoms
Some children with neurologic Lyme disease develop behavioral, neuropsychiatric, or autonomic symptoms rather than obvious focal neurologic findings.
These symptoms may include:
- anxiety
- emotional lability
- rapid heart rate
- exercise intolerance
- dizziness with standing
- gastrointestinal symptoms
Some children also develop symptoms associated with autonomic dysfunction or POTS.
Seizures and Other Rare Neurologic Manifestations
Seizures are uncommon but have been reported in children with neurologic Lyme disease.
In most cases, seizures occur alongside inflammation involving the central nervous system, such as meningoencephalitis.
Because seizures have many possible causes in childhood, careful neurologic evaluation is required to determine whether Lyme disease or another condition is responsible.
Why Neurologic Lyme Disease Can Be Missed
Neurologic Lyme disease in children may be overlooked because symptoms are not always dramatic or specific.
Children may have difficulty describing symptoms clearly, and early neurologic examinations may sometimes appear normal. :contentReference[oaicite:2]{index=2}
Children may initially receive diagnoses such as migraine, Bell’s palsy, anxiety, viral meningitis, or functional disorders before Lyme disease is considered.
Limitations of Diagnostic Testing
Evaluation may include blood tests and, in selected cases, lumbar puncture with spinal fluid analysis.
However, spinal fluid findings are not always definitive. In clinical practice, spinal tap results may occasionally appear negative or nonspecific even when neurologic Lyme disease remains part of the clinical concern. :contentReference[oaicite:3]{index=3}
Because of these limitations, the clinical picture remains an important part of the evaluation.
Clinical Course and Recovery
Many children with Lyme neuroborreliosis improve with treatment, and the overall prognosis is often favorable.
However, recovery is not always immediate. Some children continue to experience fatigue, headaches, cognitive symptoms, dizziness, or functional limitations for weeks or months after the initial illness.
Careful follow-up may be important when symptoms persist after treatment.
Clinical Perspective
Neurologic Lyme disease in children can present with facial palsy, meningitis, headaches, dizziness, fatigue, behavioral symptoms, seizures, or autonomic dysfunction.
Because symptoms may overlap with more common pediatric conditions, the diagnosis can sometimes be delayed.
Recognizing the broad neurologic manifestations of Lyme disease may help clinicians identify cases earlier and guide appropriate evaluation and care.
Reference:
Kozak S, Kaminiów K, Kozak K, Paprocka J. Lyme Neuroborreliosis in Children. Brain Sciences. 2021;11(6):758. doi:10.3390/brainsci11060758.
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
