Seizures in tuberculous meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Medicine

Background:

• Tuberculous meningitis (TBM) is a severe infection with significant neurological complications.
• Seizures are a known complication of TBM, but their frequency, timing, and impact on outcomes require further elucidation.

Purpose of the Study:

• To determine the incidence of seizures in patients with TBM.
• To investigate the potential mechanisms and associations of early and late-onset seizures.
• To evaluate the effect of seizures on patient outcomes in TBM.

Main Methods:

• A cohort of 79 patients with TBM admitted between 2014 and 2017 was retrospectively analyzed.
• Seizures were classified according to International League Against Epilepsy criteria and categorized as early (within 1 month) or late (>1 month) post-meningitis onset.
• Patient outcomes were assessed using the modified Rankin Scale (mRS), with mRS ≤ 2 considered good and mRS > 2 considered poor.

Main Results:

• Seizures occurred in 34.2% of TBM patients, with late-onset seizures (70.4%) being more common than early-onset (29.6%).
• Early seizures were associated with meningeal irritation, while late seizures correlated with tuberculoma, infarction, and hyponatremia (P=0.01).
• Seizures did not significantly affect mortality but were associated with worse six-month outcomes (P=0.03).

Conclusions:

• Seizures are a common complication in tuberculous meningitis, observed in over a third of patients.
• The occurrence of seizures, particularly late-onset seizures, is associated with poorer neurological outcomes at six months post-TBM.
• While seizures do not directly increase mortality, their presence indicates a more severe disease course and warrants close monitoring for long-term functional deficits.