Neurological symptoms of Lyme disease may include facial palsies, radiculoneuritis, and meningitis or encephalitis. Healthcare professionals treat Lyme disease with antibiotics.

Lyme disease is a bacterial infection. You get Lyme disease through being bitten by an infected tick. The early signs include a sudden rash and flu-like symptoms.

Left untreated, Lyme disease may start to affect other areas of the body, such as the heart, joints, and nervous system. This is called disseminated Lyme disease.

A variety of neurological symptoms may develop during the disseminated stage of Lyme disease.

Neurological symptoms were first associated with Lyme disease around 1922. Researchers estimate that 10% to 20% of people in North America who contract Lyme disease experience neurological symptoms.

Neurological symptoms and complications of Lyme disease start to develop in the early stages of disseminated disease. This is typically 3 to 12 weeks after infection.

When Lyme disease causes neurological symptoms, it’s sometimes called Lyme neuroborreliosis.

The neurological symptoms of Lyme disease can depend on which part of the nervous system is affected.

Cranial nerves

The 12 cranial nerves work to send information between your brain and various areas of your face, neck, and torso.

Facial nerve palsies (paralysis) can happen if the cranial nerves are involved. Paralysis is a common neurological symptom of Lyme disease. Symptoms may include drooping on one or both sides of the face.

More rarely, other cranial nerves are involved. If the optic nerve (supplying the eyes) is affected, it can lead to vision problems. Involvement of the vestibulocochlear nerve can affect hearing and balance.

Central nervous system

The central nervous system (CNS) includes the brain and spinal cord. CNS involvement in Lyme disease can result in conditions like meningitis or encephalitis.

Peripheral nervous system

The peripheral nervous system (PNS) includes the nerves outside of your CNS, which supply sensation to your limbs.

Lyme disease that affects the PNS leads to radiculoneuritis, a condition that causes pain, weakness, numbness, and tingling in your arms and legs.

When you develop an infection, the immune system jumps into action to respond to it. However, sometimes, the immune response targets healthy tissues as it works to clear the infection.

Generally speaking, the immune system’s response to Lyme disease is associated with damage to the nervous system and other tissues.

Some research also suggests that a protein on the outer surface of the bacteria called OspC also contributes to neuroborreliosis. Experts believe that certain variants of OspC promote the bacteria’s spread to the nervous system and cause neurological symptoms of Lyme disease.

Diagnosis

A healthcare professional may assess the following to confirm whether neurological symptoms are due to Lyme disease:

Doctors typically follow a two-step testing approach for Lyme disease diagnosis. This means using two different tests that look for antibodies to the bacteria in your blood.

If the first test is negative, no further testing is recommended. However, if the results of the first test are unclear or positive, the healthcare professional will use a second test to confirm the diagnosis.

It’s possible that a sample of cerebrospinal fluid (CSF), which surrounds your brain and spinal cord, may also be extracted to look for signs of bacteria. However, this isn’t a standard part of Lyme disease diagnosis.

Other tests to help rule out other conditions that cause similar symptoms may include:

Treatment

Healthcare professionals typically treat the neurological symptoms of Lyme disease with antibiotics. These are medications that attack bacteria.

Doxycycline or ceftriaxone are antibiotic treatments for Lyme disease. A doctor may treat neurological symptoms with these drugs for 14 to 21 days.

Doxycycline is taken orally (by mouth), while ceftriaxone is given intravenously (by IV).

Doxycycline is also used for facial palsies, while either doxycycline or ceftriaxone may be used for meningitis or radiculoneuritis.

According to the National Institute of Neurological Disorders and Stroke (NINDS), many people with neurological symptoms due to Lyme disease respond well to antibiotics.

Some people may have further symptoms, such as fatigue, brain fog, and aches and pains, for up to 6 months after treatment. This is called post-treatment Lyme disease syndrome and can affect up to 20% of people recovering from Lyme disease.

Additionally, it’s possible to have lasting neurological problems even after receiving treatment for Lyme disease.

A 2023 study of 103 people with Lyme neuroborreliosis found that 76 people (73.8%) had lingering neurological symptoms. The most common was unresolved facial palsies (38.8%). Others included:

Some people with Lyme disease can experience neurological symptoms if the infection isn’t treated in its early stages. These symptoms can include things like facial palsies, radiculoneuritis, and meningitis.

A healthcare professional can use a variety of tests to evaluate the root of neurological symptoms. If the cause is Lyme disease, they will use antibiotics to treat the condition.

Many people with Lyme disease and neurological symptoms respond well to treatment. However, for some people, symptoms may linger following treatment.