Related Experiment Video
Updated: Jun 11, 2025
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Seizure prophylaxis in pneumococcal meningitis, cohort study
Lluïsa Guillem1, Guillermo Hernández-Pérez2, Damaris Berbel3
1Department of Clinical Sciences, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain.
Objective:
Our aim was to assess seizure development as a complication of pneumococcal meningitis and its possible prevention with antiseizure medication prophylaxis.
Methods:
Antiseizure medication (ASM) prophylaxis has been practiced for a long time at our center. We assessed all cases of community-acquired pneumococcal meningitis admitted from January 2010 to April 2021 recorded in our prospective database and conducted further retrospective studies.
Results:
Of the 86 cases recorded, 21 (24.4%) developed acute symptomatic seizures, more than half of which (11/21; 52.4%) before admission. Seizure development increased the need for orotracheal intubation and intensive care unit admission, while also lengthening hospital stays and suggesting more risk of death and disability at discharge [adjusted odds ratio (aOR), 3.13; 95% confidence interval (CI): 1-9.8]. Of the 74 patients eligible for ASM prophylaxis, 64 received it and 10 did not. ASM prophylaxis seemed effective in preventing seizure development, as only six seizure events were recorded in 64 patients with ASM prophylaxis (9.4%) compared with four in the 10 patients without prophylaxis (40%). Its preventive capacity was especially notable when administered within 4 h of admission. Differences in mortality did not reach statistical significance. Adverse effects were rare.
Significance:
Seizure development is a common complication in pneumococcal meningitis and is associated with increased risks of Intensive Care Unit admission, orotracheal intubation, and longer hospital stays. ASM prophylaxis may be effective in blocking seizure development in patients with preventable seizures and may be associated with better prognosis. Further studies are now warranted.
Plain Language Summary:
Infection of the meninges (the covering of the brain) due to the common bacteria S pneumoniae, used to be a fatal disease before the introduction of antibiotics and corticoids. Thanks to these drugs, more people survive this disease but, due to the frequent complications, they may have several sequelae. Seizures are a common complication. Our study suggests that they might be prevented by using antiseizure drugs which may reduce both severity and hospital stay.
Insights
Seizures are a common complication of pneumococcal meningitis, increasing risks for patients. Antiseizure medication prophylaxis may effectively prevent seizures, potentially improving patient outcomes and reducing hospital stays.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Pneumococcal meningitis, an infection of the brain's covering, historically had high mortality.
- While antibiotics and corticoids improve survival, complications like seizures remain significant sequelae.
- Seizures are a frequent complication impacting patient recovery and prognosis.
Purpose of the Study:
- To assess the incidence of seizures as a complication of pneumococcal meningitis.
- To evaluate the potential of antiseizure medication (ASM) prophylaxis in preventing these seizures.
- To determine the impact of ASM prophylaxis on patient outcomes.
Main Methods:
- Retrospective analysis of a prospective database of community-acquired pneumococcal meningitis cases (January 2010 - April 2021).
- Assessment of seizure development in patients, comparing those who received ASM prophylaxis with those who did not.
- Evaluation of the timing of ASM administration relative to seizure occurrence.
Main Results:
- 24.4% of 86 patients developed acute symptomatic seizures, often before hospital admission.
- Seizure development was linked to increased need for intubation, ICU admission, longer hospital stays, and higher risk of death/disability.
- ASM prophylaxis (64/74 patients) was associated with significantly lower seizure incidence (9.4% vs. 40%) and was most effective when given within 4 hours of admission.
Conclusions:
- Seizure development is a common and serious complication of pneumococcal meningitis.
- Antiseizure medication prophylaxis shows promise in preventing seizures and may improve prognosis.
- Early administration of ASM prophylaxis could mitigate severe outcomes associated with pneumococcal meningitis.
