Neurologic Lyme disease occurs when Lyme disease bacteria invade and affect the nervous system. Symptoms include numbness, pain, facial droop, neck pain, vision changes, and more.

Lyme disease is transmitted through an infected tick’s bite. The infection can be chronic and it usually affects the joints and causes flu-like symptoms. The bacteria can also affect the cranial, peripheral, and central nervous system (CNS), causing a range of neurological symptoms.

Neurologic Lyme disease — also called neuroborreliosis or Lyme neuroborreliosis — occurs in up to 15% of people with Lyme disease. In every 100 cases of Lyme disease, there are approximately:

This article explores neurologic Lyme disease in more detail, including its symptoms, causes, and treatment. It also discusses Lyme disease diagnosis and an outlook.

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Neurological symptoms often occur early in the course of Lyme disease. They typically occur 3-5 weeks from the initial bite and after the flu-like symptoms that people commonly experience at the start of the infection.

Lyme neuroborreliosis may affect the CNS, including the brain and spinal cord. It may also affect the peripheral nervous system (PNS), including motor and sensory nerves.

Various inflammatory conditions can occur due to neurologic Lyme disease. However, a classic triad commonly appears in a typical nervous system Lyme disease. This triad includes:

  • Radiculoneuritis: This is the simultaneous inflammation of the motor and sensory spinal nerve roots. It can result in muscle weakness or paralysis and sensory symptoms, including tingling, numbness, and sharp pain.
  • Cranial neuritis: This occurs when the cranial nerves become inflamed. These nerves emerge from the brainstem. They are necessary for essential functions, including:
    • eye movements
    • vision
    • hearing
    • taste
    • balance
    • head-turning
    • smell
    • facial expression
    • chewing
    • tongue movement
  • Lymphocytic/monocytic meningitis: This is a form of meningitis caused by a predominance of lymphocytes in the cerebrospinal fluid (CSF). Symptoms include headache, stiff neck, and extreme sensitivity to light.

Facial nerve palsy is also common and may affect one or both sides of the face. Meanwhile, CNS involvement is rare. However, it may include:

Some people may notice other problems in the following weeks, months, or even years. The problems may include:

However, young children may only present with nonspecific symptoms such as headaches, loss of appetite, behavior problems, and fatigue.

Lyme disease is transmitted through a bite of blood-feeding hard-shelled Ixodes ticks. However, they are usually attached for at least 36-48 hours before the bacterium is transmitted.

Different types of Ixodes are common in other parts of the world, and there are three types of species causing Lyme disease. Typically, the Borellia burgdorferi bacterium causes Lyme disease in the United States.

The infection travels through the bloodstream and lymphatic system. It reaches the brain, crosses the blood-brain barrier (BBB), and infiltrates the nervous system.

Most people with Lyme disease respond well to antibiotics such as doxycycline and ceftriaxone. However, doxycycline is not approved by the Food and Drug Authority (FDA) for children under 8 years old.

The typical duration of treatment is from 14-21 days. However, early treatment may last 7–14 days.

An infectious disease specialist may decide and adjust the antibiotic regimen based on a person’s:

  • age
  • underlying health conditions
  • medical history
  • allergies
  • pregnancy status

The most tell-tale sign of Lyme disease is a circular bulls-eye-like rash called erythema migrans. However, it is not always present.

Lyme disease can be challenging to diagnose because it can have many nonspecific symptoms that are similar to symptoms of other conditions.

More importantly, neurological Lyme disease can resemble and be mistaken for many other conditions. Therefore, it is important for a healthcare professional to make a correct diagnosis. Some of these conditions include:

Currently, doctors perform blood tests and physical exams to diagnose neurological Lyme disease.

The Centers for Disease Control and Prevention (CDC) recommends a two-step testing process for Lyme disease.

The first test is an enzyme immunoassay or immunofluorescence assay to check for Borrelia antibodies in the blood. If the test does not detect Lyme disease, a person does not proceed to the next test.

If the first test detects antibodies, a healthcare professional then performs a Western blot test to confirm the diagnosis. Antibodies are evidence that the body has been exposed to the bacteria, and the Western blot detects parts of the bacteria itself.

Healthcare professionals may perform the same process on a CSF sample.

A person’s body may take several weeks before the immune system can make enough antibodies that the test can detect. This means that the sensitivity of antibody tests during this window period is lower.

Additionally, antibody tests may show a false positive result when a person has other tick-borne diseases, bacterial or viral infections, or autoimmune diseases.

Many individuals with Lyme disease respond well to treatment and experience full recovery.

However, late-stage Lyme neuroborreliosis and complications may occur if healthcare professionals do not detect Lyme disease early. The prevalence of late-stage symptoms varies, and there are different reasons for prolonged symptoms.

It is common for people with late-stage Lyme disease to experience permanent joint and nervous system damage to varying degrees.

Residual symptoms are not uncommon in neurological Lyme disease and when treatment is delayed.

Around 10-20% of people with Lyme disease experience persistent symptoms 6 months after receiving antibiotics and other treatments. This condition is called post-treatment Lyme disease syndrome. It may be an inflammatory or autoimmune response to the infection.

Neurologic Lyme disease occurs when the bacteria causing Lyme disease invade the nervous system, leading to neurological symptoms and inflammatory conditions. These vary widely from tingling and numbness to neuritis and meningitis.

It typically occurs in individuals whose Lyme disease is not treated promptly with antibiotics.

Early recognition and prompt treatment may prevent the infection from progressing to more severe stages. However, this may be challenging due to the difficulty of diagnosing Lyme disease accurately.

A person should carefully monitor suspected tick bites and consult a healthcare professional if they think they are at risk of Lyme disease. A healthcare professional can conduct tests to help diagnose the condition.