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Seizures and other neurologic sequelae of bacterial meningitis in children
S L Pomeroy1, S J Holmes, P R Dodge
1Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
Insights
Children with persistent neurologic deficits after bacterial meningitis face a high risk of developing epilepsy. Those without lasting deficits after acute illness are unlikely to experience long-term neurological issues, including seizures.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Bacterial meningitis mortality has decreased, but neurological sequelae persist in some children.
- Predictors of chronic neurological sequelae, such as epilepsy, following acute bacterial meningitis remain unclear.
Purpose of the Study:
- To identify features of acute bacterial meningitis that predict chronic neurological sequelae, specifically late seizures or epilepsy.
Main Methods:
- Prospective follow-up of 185 infants and children after acute bacterial meningitis.
- Mean follow-up duration of 8.9 years, utilizing neurologic examinations and telephone interviews.
Main Results:
- 37% had neurological abnormalities one month post-meningitis; 14% had persistent deficits (hearing loss or multiple deficits).
- 7% experienced late, afebrile seizures.
- Persistent neurological deficits were the sole independent predictor of late afebrile seizures (P < 0.001).
Conclusions:
- Children with permanent neurological deficits post-bacterial meningitis are at high risk for epilepsy.
- Normal neurological examinations after acute illness indicate a low risk of serious long-term neurological sequelae, including epilepsy.
Background:
Although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades, some patients are left with neurologic sequelae. It has not been clearly established which features of the acute illness predict the chronic neurologic sequelae, including late seizures or epilepsy.
Methods:
We followed 185 infants and children prospectively during and after acute bacterial meningitis. The mean duration of follow-up was 8.9 years (range, 0.1 to 15.5). During the first six years standard neurologic examinations were performed; telephone interviews were conducted thereafter.
Results:
One month after meningitis, 69 children (37 percent) had neurologic abnormalities. Many of these signs resolved within a year, leaving only 26 children (14 percent) with persistent deficits: 18 (10 percent) had only sensorineural hearing loss, and 8 (4 percent) had multiple neurologic deficits. Thirteen children (7 percent) had one or more late seizures not associated with fever. The presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures (P less than 0.001).
Conclusions:
After bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy. Those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae, including epilepsy.