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Seizure disorders associated with neurosyphilis
Diseases of the Nervous System
|March 1, 1976
Summary
Neurosyphilis can cause adult onset seizures. Using FTA-ABS tests and high-dose penicillin improves diagnosis and treatment outcomes for these neurological disorders.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Neurosyphilis is a significant cause of acquired neurological disorders.
- Repetitive adult onset seizures can be a manifestation of neurosyphilis, often of unknown etiology.
- Traditional non-treponemal serologic tests have limitations in diagnosing neurosyphilis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of serologic tests for neurosyphilis in patients with adult onset seizures.
- To assess the efficacy of penicillin treatment in neurosyphilitic patients with seizures.
- To determine the prognostic factors influencing seizure control in neurosyphilis.
Main Methods:
- Retrospective analysis of 282 neurosyphilitic patients, identifying 68 with repetitive adult onset seizures.
- Comparison of the diagnostic performance of serum and cerebrospinal fluid (CSF) Fluorescent Treponemal Antibody Absorption (FTA-ABS) tests versus non-treponemal serologic tests.
- Evaluation of treatment outcomes in patients receiving procaine penicillin G, alongside standard anticonvulsants, compared to non-syphilitic patients.
Main Results:
- Twenty-four percent of neurosyphilitic patients presented with repetitive adult onset seizures.
- Serum and CSF FTA-ABS tests demonstrated higher diagnostic accuracy than non-treponemal tests, which were reactive in only 54.5% of cases.
- The therapeutic failure rate for seizures in neurosyphilitic patients treated with high-dose penicillin was 17.3%, lower than in non-syphilitic controls (21.8-38.6%).
- General paresis of the insane (GPI) was associated with the poorest seizure prognosis, irrespective of treatment modality.
Conclusions:
- Serum and CSF FTA-ABS testing should be incorporated into the diagnostic workup for adult onset seizures of uncertain cause.
- Aggressive penicillin therapy, utilizing high doses, appears to enhance treatment success rates for neurosyphilis-related seizures.
- Early and accurate diagnosis of neurosyphilis is crucial for effective management of associated seizure disorders.
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