Seizures are often attributed to primary neurological disorders such as epilepsy, brain injury, or genetic conditions. But what happens when a patient develops seizures without a clear cause – and does not respond to standard treatment? Increasingly, research and clinical experience suggest that in some cases, the underlying issue may not be purely neurological, but immunological and infectious in origin.
One emerging and underrecognized connection is the role of Lyme disease in triggering autoimmune encephalitis, a condition that can manifest with seizures, psychiatric symptoms, and profound neurological dysfunction.
Understanding Autoimmune Encephalitis
Autoimmune encephalitis occurs when the immune system mistakenly attacks the brain, leading to inflammation. This inflammation can disrupt normal neuronal signaling and result in symptoms such as seizures, memory loss, confusion, behavioral changes, and psychosis.
In many cases, autoimmune encephalitis is associated with antibodies targeting neuronal receptors, such as NMDA or GABA receptors. However, what is often overlooked is the trigger for this immune response in the first place.
The Infectious Trigger: Lyme Disease
Lyme disease, caused by the bacterium Borrelia burgdorferi, is well known for its ability to affect multiple systems in the body. While early symptoms may include fatigue, joint pain, or a rash, the infection can also invade the nervous system – a condition known as neuroborreliosis.
In some patients, Lyme disease appears to act as a trigger for autoimmune activity in the brain. Rather than direct damage from the bacteria alone, the immune system becomes dysregulated, leading to ongoing inflammation even after the initial infection. This mechanism is similar to that seen in other post-infectious autoimmune conditions, where the body’s attempt to fight an infection inadvertently causes damage to its own tissues.
When Seizures Are Not “Just Epilepsy”
In clinical practice, patients with Lyme-associated autoimmune encephalitis may present with new-onset seizures without prior history, seizures that are difficult to control with medication, cognitive decline or memory impairment, and psychiatric symptoms such as anxiety, depression, or hallucinations.
These patients are often diagnosed with epilepsy or a psychiatric disorder, while the underlying cause remains unrecognized. Standard imaging and routine lab tests may be normal, leading to further confusion and, in many cases, delayed treatment.
This connection is not just theoretical. In my published, peer-reviewed case series, “Autoimmune Epilepsy Temporally Associated with Lyme Disease: A Report of Two Cases,” I documented patients who developed seizure disorders linked to Lyme-triggered autoimmune processes, highlighting the importance of recognizing infection as a potential underlying cause.
The Role of Inflammation and Immune Dysregulation
One of the key features of Lyme-associated neurological disease is chronic inflammation. The immune system, once activated, may remain in a heightened state, producing cytokines and antibodies that continue to affect brain function.
Additionally, Lyme disease is frequently accompanied by co-infections such as Bartonella or Babesia, which can further complicate the immune response and contribute to neurological symptoms.
Challenges in Diagnosis
Diagnosing autoimmune encephalitis related to Lyme disease can be challenging
for several reasons:
- Lyme testing is not always sensitive or reliable
- Autoimmune markers may not always be present or may be overlooked
- Symptoms can mimic psychiatric or neurological conditions
As a result, many patients go undiagnosed or are treated symptomatically without addressing the root cause. A thorough clinical evaluation – including a detailed history of tick exposure, symptom progression, and associated systemic symptoms – is critical.
A More Comprehensive Treatment Approach
When Lyme disease is suspected as a contributing factor, treatment must address both the underlying infection and the immune response. This may include antimicrobial therapy targeting Lyme and co-infections, anti-inflammatory and immune-
modulating strategies, nutritional and metabolic support, and seizure management when necessary.
In some cases, patients who have not responded to traditional seizure medications begin to improve once the underlying inflammatory process is addressed.
Why This Matters
The connection between Lyme disease, autoimmune encephalitis, and seizures is not yet widely recognized – but it has profound implications. For patients, it can mean the difference between lifelong seizure management and identifying a treatable underlying cause. For clinicians, it highlights the importance of looking beyond conventional diagnoses and considering infectious and immune-mediated contributors to neurological disease.
Moving Forward
As research evolves, it is becoming increasingly clear that the immune system, infections, and environmental exposures all play a role in neurological health. Lyme disease, in particular, has demonstrated an ability to disrupt this balance in complex ways that are still being understood.
Seizures are not always what they seem. They may signal deeper immune dysfunction triggered by infection. Recognizing the potential link between Lyme disease and autoimmune encephalitis opens the door to more accurate diagnoses, more effective treatments, and, most importantly, better outcomes for patients who have too often been overlooked.
Pamela M. Cipriano, DNP, ACNP-BC, is a nurse practitioner specializing in internal medicine, functional medicine, and complex chronic illnesses, including Lyme disease, mold toxicity, and autoimmune disorders. She is the founder of The Practice of Health and Wellness in Thomaston, Connecticut, an ILADS-trained Lyme specialist, national speaker, and award-winning clinician dedicated to educating patients and providers about the hidden manifestations of tick-borne diseases.
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