Quick answer
Neurological Lyme disease, also called Lyme neuroborreliosis, happens when Lyme bacteria affect the nervous system. The most common forms are facial palsy, nerve root pain (radiculoneuritis) and meningitis. It usually appears weeks to months after a tick bite and is treated with antibiotics for 14 to 21 days. Most people recover well.
- According to CDC’s clinical guidance, per 100 reported Lyme cases about 9 involve facial palsy, 4 involve radiculopathy (nerve root problems) and 3 involve meningitis or encephalitis. A separate CDC surveillance report on confirmed cases from 2008 to 2015 found slightly different shares, shown in the table below. CDC notes reporting may overstate how often doctors see these.
- Neurologic complications most often occur in early disseminated Lyme disease, after the infection has spread.
- Treatment: doxycycline by mouth for 14 to 21 days, or IV ceftriaxone for meningitis or radiculoneuritis, as your care team decides (CDC).
- Most people respond well to antibiotics and recover fully. People who go untreated and progress to late disease can develop lasting nerve damage.
The main types of neurological Lyme disease
Doctors group neurologic Lyme by which part of the nervous system is involved. CDC and the 2020 IDSA/AAN/ACR guideline describe three main patterns.
1. Cranial neuritis (facial palsy)
The facial nerve is the cranial nerve most often affected. It causes drooping on one or both sides of the face. It is the most common neurologic sign of Lyme disease. Our Lyme disease face page covers what it looks like and how recovery goes.
2. Radiculoneuritis (nerve root pain)
This is inflammation of the nerve roots as they leave the spine. CDC describes numbness, tingling, shooting pain or weakness in the arms, legs or trunk. The pain can be severe. CDC advises doctors to consider Lyme in people with severe limb or trunk nerve pain and no injury who live in or visited Lyme areas.
3. Lyme meningitis
Meningitis is inflammation of the membranes around the brain and spinal cord. CDC lists fever, severe headache, stiff neck and sensitivity to light. A spinal tap is not required to diagnose Lyme meningitis, but it can help rule out other bacterial causes.
Rarer forms
Inflammation of the brain or spinal cord itself (encephalitis or myelitis) is uncommon. In CDC surveillance data from 2008 to 2015, encephalitis appeared in under 1 percent of confirmed cases with clinical details. When the brain or spinal cord is involved, the guideline prefers IV antibiotics over oral ones.
| Type | Typical symptoms | Share of confirmed cases (CDC data, 2008 to 2015) |
|---|---|---|
| Facial palsy | Drooping on one or both sides of the face | 8.4% |
| Radiculoneuropathy | Shooting pain, numbness, tingling, weakness | 3.8% |
| Meningitis | Fever, severe headache, stiff neck, light sensitivity | 1.3% |
| Encephalitis | Confusion or other brain symptoms | Under 1% |
When neurological symptoms appear
Neurologic Lyme most often shows up in the early disseminated stage, weeks to a few months after the bite, when the bacteria have spread beyond the skin. Some people never had or noticed the rash. See the stages of Lyme disease for the full timeline.
MedlinePlus notes that untreated late-stage Lyme can cause numbness and tingling, speech problems and problems with thinking. Early treatment helps prevent this.
How it is diagnosed
CDC recommends standard two-step blood testing for neurologic Lyme disease. Doctors also weigh tick exposure, travel, symptoms and exam findings. CDC points out that neurologic symptoms in someone with Lyme do not always mean the infection is inside the central nervous system. Learn more about Lyme disease testing.
Treatment and recovery
CDC lists 14 to 21 days of antibiotics for facial palsy, meningitis and radiculoneuritis in adults and children. Oral doxycycline is an option for all three. IV ceftriaxone may be used for meningitis or radiculoneuritis, especially when someone is in the hospital, with a switch to pills once they are stable. Your provider may adjust the plan for age, pregnancy, allergies or other conditions. See our full Lyme disease treatment guide.
Most people respond well and recover fully. Some symptoms, such as nerve pain or facial weakness, can take time to fade after the infection is treated. If symptoms linger after treatment, our page on chronic Lyme disease and PTLDS explains what is known.
Can Lyme disease cause seizures?
Seizures are not among the neurologic signs CDC lists for Lyme disease. We look at the evidence in detail in can Lyme disease cause seizures? Anyone having a seizure for the first time needs emergency care, whatever the cause.
We are collecting real experiences about neurological Lyme disease from people who have lived it, shared with their permission. As stories come in, they will appear here, clearly marked as personal experience rather than medical advice.
Seek care the same day for a severe headache with stiff neck, fever and light sensitivity; new facial drooping; or severe shooting pain or weakness in a limb.
Call 911 for a seizure, confusion, sudden weakness on one side, trouble speaking, or sudden face drooping, which can be signs of a stroke or another emergency.
Frequently asked questions
What are the symptoms of neurological Lyme disease?
Facial drooping, shooting nerve pain, numbness or tingling, limb weakness, and meningitis symptoms such as severe headache, stiff neck, fever and light sensitivity. CDC also lists visual disturbances.
How common is neurological Lyme disease?
In CDC reports, about 9 in 100 cases involve facial palsy, 4 in 100 nerve root problems and 3 in 100 meningitis or encephalitis.
Is neurological Lyme disease treatable?
Yes. CDC lists 14 to 21 days of antibiotics, by mouth or through an IV depending on the form. Most people recover fully.
Can Lyme disease cause permanent nerve damage?
CDC says permanent nervous system damage may develop in people who are not treated early and progress to late-stage disease. Early treatment lowers that risk.
Can Lyme disease cause seizures?
Seizures are not on CDC’s list of typical neurologic signs. See our seizures page for the evidence.