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Aseptic meningitis:
Usually manifested by headache, neck stiffness, fever and disorientation or confusion. It is often mild and may not be sufficient to result in the patient seeking medical attention This may last for hours, days or months, but typically occurs in the initial stages.

Seizures:
Often characterized by abrupt transient loss of consciousness, twitching and jerking. Respiratory distress may occur in a percentage of patients. EEGs may be done to assist in the diagnosis, but findings are not specific to Lyme disease.

Encephalopathy:
Characterized by more chronic cognitive changes, which may involve impaired speech (both receptive and expressive), disorientation, impaired memory, irritability and decreased level of awareness to one's environment. There may be a number of other neuropsychiatric changes, detailed well by Drs. Fallon, et al. Patients with chronic Lyme disease may initially be misdiagnosed with a primary psychiatric disorder. Children with neuroborreliosis may present with developmental delay or, later, with school failure or symptoms of attention deficit disorder, thus being mislabeled as having attention deficit hyperactivity disorder. Whereas ADHD as a primary diagnosis is much more common, neuroborreliosis needs to be included as a possibility, particularly in the child who is exhibiting other possible symptoms of Lyme disease.

Increased intracranial pressure:
Reported in several children with Lyme disease, this would typically present with headaches, double vision and, occasionally, vomiting. In my view, this has been erroneously reported as a "pseudotumor cerebri-like" syndrome. True pseudotumor cerebri is defined by elevated intracranial pressure after the exclusion of all potential causes, including chronic infection. Thus, I think that this title is not accurate and may be misleading.

Extrapyramidal system:
This may be involved in Lyme disease, with symptoms ranging from muscle jerks, rigidity, tremors, exaggerated sleep jerks (myoclonus), tics and cramps.

Cerebellum:
Possibly involved in Lyme disease as manifested by ataxia, a medical term meaning poorly coordinated gait, often accompanied by frequent falling. Ataxia is a symptom, not a diagnosis, and can occur from impairment in different areas of the nervous system

Brainstem:
It can be affected by Lyme disease due to cranial nerve palsies. Cranial nerve involvement has been reported in virtually all of the cranial nerves. Vertigo and dizziness/dysequilibrium from both CNS and PNS dysfunction have been reported with Lyme disease.

Spinal cord:
Transverse myelitis:
An acute disorder of the spinal cord involving area(s) of inflammation or infection that causes motor or sensory malfunction, possibly leading to permanent impairments. As such, it may be due to a variety of possible causes, including multiple sclerosis, viruses or Lyme disease, all of which merit careful investigation.

Peripheral Nerve:
Peripheral neuropathies:
These have been reported, although they are said to be less common in children. They may be sensory (involving abnormal or diminished sensation), which may involve pain, tightness, numbness and tingling or other unusual sensations. Motor neuropathies typically involve weakness and reduced muscle strength and/or bulk in the affected area. Often peripheral neuropathies are mixed motor and sensory.

Radiculoneuropathies:
Involve irritation at the level of the nerve root, where the peripheral nerve joins the spinal cord. Typically, there is pain or discomfort near the spine. Both radiculoneuropathies and peripheral neuropathies may be further defined by eloctromyography and nerve conduction studies (EMG/NCVs), the findings of which are not specific to, or diagnostic of, Lyme disease.

Neuromuscular Junction:
Myasthenia Gravis-like syndrome:
Rarely reported in children, it involves a decrement in muscle power with sustained muscle contraction. This must be confirmed by EMG/NCV.

Muscle:
Myositis:
This is common among patients with both early and late chronic Lyme disease. Muscle symptoms include muscle tenderness, stiffness, cramping and muscle swelling.

In summary, Lyme disease may affect virtually any area of the nervous system and lead to a variety of manifestations, either in isolation or in combination. In addition, as more appropriately reviewed elsewhere, Lyme disease is foremost a clinical diagnosis, with marked difficulties in establishing confirmatory laboratory tests. In addition, concomitant infections may exist, which often need to be addressed. Furthermore, there exists ongoing controversy regarding the duration and nature of therapy, although it can be stated unequivocally that therapy must be individualized.

Lyme disease in children may affect the nervous system in virtually every way that it can in adults, plus it has the added potential for detrimental effects on the developing brain in particular. Pediatricians and pediatric subspecialists face the added challenge of the developmental limitations involved in conveying symptoms from patient to physician.