Clinical manifestations of Lyme disease (LD) in 97 seropositive children were reviewed at the Children’s Hospital of Philadelphia, with particular attention to neurologic symptoms and signs. Of 69 children with LD, 22 (32%) had new neurologic abnormalities, mainly facial palsy and aseptic meningitis. Only 27% of children with neurologic abnormalities due to LD had a history of erythema migrans or arthritis. Seropositivity for LD and neurologic symptoms usually indicates an active neuroborreliosis. 
COMMENT. Definite evidence for neuroborreliosis requires characteristic neurologic abnormalities and either erythema migrans, arthritis or heart involvement, positive spinal fluid serology, or seroconversion. Peripheral neuropathy is infrequent in children compared to adults. Facial palsy and aseptic meningitis are the most frequent neurologic manifestations of LD in children. In the approaching summer months, children presenting with these disorders should be checked for possible Lyme disease.