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Related Concept Videos

Cranial and Spinal Meninges01:19

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Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
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Seizures in tuberculous meningitis.

Usha K Misra1, Mritunjai Kumar1, Jayantee Kalita1

  • 1Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

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|November 6, 2018
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Summary

Seizures affect over a third of tuberculous meningitis patients, often occurring later in the disease. These seizures are linked to poorer outcomes at six months but do not impact mortality.

Keywords:
Early seizuresHyponatremiaSeizuresStatus epilepticusTuberculous meningitis

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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.