Prevalence and factors associated with seizures in tuberculous meningitis

Tuberculous meningitis (TBM) is a severe manifestation of extrapulmonary tuberculosis that can lead to debilitating neurological complications. Seizures in TBM pose diagnostic and therapeutic challenges and are associated with adverse outcomes and prolonged hospitalisation. This study aims to determine the prevalence, risk factors, and outcomes associated with seizures in patients with TBM patients.

A retrospective observational study was conducted on 96 adult patients diagnosed with TBM at a tertiary hospital in Malaysia. Patients with the diagnosis of tuberculous meningitis were included and classified into the seizures and non-seizures groups. Clinical, laboratory, radiological, and treatment-related variables were analysed. Antiseizure medication use and neurological outcomes were also assessed.

Seizures occurred in 30.2% (n=29) of patients; generalized seizures were the predominant type. Patients with seizures were more likely to present with altered behaviour (48.3% vs 31.3%) and focal neurological deficits (24.1% vs 14.9%). Patients with seizures were more likely to be on antiseizure medications, particularly phenytoin, valproate and levetiracetam (p<0.05). Lower Glasgow Coma Scale scores on admission were more common among seizure patients (17.2%) compared to non seizure group (7.5%). Patients with seizures had higher rates of mortality (27.6% vs. 13.4%) and poor functional outcomes compared to those without seizures.

Seizures are common in TBM and are associated with worse clinical outcomes. Early clinical signs such as altered behaviour and focal deficits may help identify high-risk TBM patients with seizures. Seizures in TBM are associated with worse neurological outcomes. The common antiseizure therapy initiated for treatment include phenytoin, valproate and levetiracetam. Further prospective studies are needed to refine risk stratification and optimize management.