Usha K Misra1, Mritunjai Kumar2, Jayantee Kalita2. 1. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Electronic address: drukmisra@sgpgi.ac.in. 2. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Abstract
OBJECTIVE: We report the frequency of seizure, its possible mechanisms and effect of seizure on the outcome of tuberculous meningitis (TBM). METHODS: Seventy-nine patients with TBM admitted during 2014-2017 were evaluated. The seizures were categorized as per International League Against Epilepsy as well as into early (within 1 month of meningitis) and late (>1 month) seizure. The possible association of seizures was recorded and the outcome was assessed using modified Rankin Scale (mRS ≤ 2 as good, and mRS > 2 as poor). RESULTS: The median age was 27 (18-76) years and 43 (54.4%) of whom were females. Tuberculous meningitis was definite in 31 (39.2%) and highly probable in the remaining. Seizures occurred in 27 (34.2%): early onset in 8 (29.6%) and late in 19 (70.4%) patients. The seizures were focal in 11(13.9%), focal to bilateral in 9 (11.4%), generalised tonic clonic in 7 (8.9%) and status epilepticus in 6 (7.6%) patients. Early seizures were associated with meningeal irritation and late seizures with tuberculoma, infarction and hyponatremia (P = 0.01). Seizure did not affect the mortality but were associated with worse six months outcome (P = 0.03). CONCLUSION: Seizures occurred in 34% patients with TBM and were associated with poor outcome at six months.
OBJECTIVE: We report the frequency of seizure, its possible mechanisms and effect of seizure on the outcome of tuberculous meningitis (TBM). METHODS: Seventy-nine patients with TBM admitted during 2014-2017 were evaluated. The seizures were categorized as per International League Against Epilepsy as well as into early (within 1 month of meningitis) and late (>1 month) seizure. The possible association of seizures was recorded and the outcome was assessed using modified Rankin Scale (mRS ≤ 2 as good, and mRS > 2 as poor). RESULTS: The median age was 27 (18-76) years and 43 (54.4%) of whom were females. Tuberculous meningitis was definite in 31 (39.2%) and highly probable in the remaining. Seizures occurred in 27 (34.2%): early onset in 8 (29.6%) and late in 19 (70.4%) patients. The seizures were focal in 11(13.9%), focal to bilateral in 9 (11.4%), generalised tonic clonic in 7 (8.9%) and status epilepticus in 6 (7.6%) patients. Early seizures were associated with meningeal irritation and late seizures with tuberculoma, infarction and hyponatremia (P = 0.01). Seizure did not affect the mortality but were associated with worse six months outcome (P = 0.03). CONCLUSION:Seizures occurred in 34% patients with TBM and were associated with poor outcome at six months.
Authors: Joseph Donovan; Ursula K Rohlwink; Elizabeth W Tucker; Nguyen Thi Thu Hiep; Guy E Thwaites; Anthony A Figaji Journal: Wellcome Open Res Date: 2019-10-31
Authors: Katelyn A Pastick; Ananta S Bangdiwala; Mahsa Abassi; Andrew G Flynn; Bozena M Morawski; Abdu K Musubire; Prosperity C Eneh; Charlotte Schutz; Kabanda Taseera; Joshua Rhein; Kathy Huppler Hullsiek; Melanie R Nicol; Jose E Vidal; Noeline Nakasujja; Graeme Meintjes; Conrad Muzoora; David B Meya; David R Boulware Journal: Open Forum Infect Dis Date: 2019-11-05 Impact factor: 3.835