Neurologic abnormalities of late Lyme disease usually develop a year or more after illness onset:

• progressive encephalomyelitis
• focal encephalitis
• cerebral vasculitis
• stroke
• multi-infarct dementia
• leukoencephalitis
• brain stem encephalitis
• late encephalopathy
• cerebellar ataxia
• transverse myelitis
• progressive spastic paraparesis or quadriparesis
• cognitive deficits
• affective disturbance
• seizures

The most common late CNS abnormalities are vague neuropsychiatric deficits such as somnolence, emotional lability, depression, impaired memory, and behavioral symptoms. The best-defined late CNS abnormality, however, is progressive Borrelia encephalomyelitis.27

Seizures can occur in 7% of these cases.25 Focal motor, partial complex, and generalized convulsions can all occur.

Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised March 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.