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Convulsions in tuberculous meningitis
A K Patwari1, S Aneja, R N Ravi
1Department of Pediatrics, Lady Hardinge Medical College & Associated Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Seizures are common in children with tuberculous meningitis (TBM). Investigations reveal cerebral edema, SIADH, and hydrocephalus as frequent causes of convulsions in pediatric TBM patients.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Tuberculous meningitis (TBM) is a severe infection affecting children.
- Convulsions are a frequent and serious complication of TBM.
- Identifying the cause of seizures is crucial for effective management.
Purpose of the Study:
- To investigate the underlying causes of convulsions in children diagnosed with TBM.
- To correlate clinical presentation, EEG, and CT scan findings with seizure types and etiology.
Main Methods:
- Retrospective analysis of 136 children under 12 hospitalized with TBM.
- Evaluation of seizure types, electroencephalogram (EEG) findings, and computed tomography (CT) scan results.
- Correlation of clinical data with neuroimaging and electrophysiological findings.
Main Results:
- 101 children (74%) experienced seizures; generalized tonic-clonic seizures (GTCS) were most common (58%).
- EEG abnormalities were frequent, especially in focal seizures (FS) and GTCS presenting late.
- CT scan abnormalities, including meningeal enhancement and hydrocephalus, were associated with specific seizure patterns and disease progression.
Conclusions:
- Convulsions in pediatric TBM are multifactorial, with cerebral edema, SIADH, and hydrocephalus being primary contributors.
- Neuroimaging and EEG play vital roles in elucidating the pathophysiology of seizures in TBM.
- Early identification of seizure causes can guide therapeutic interventions in TBM.
Abstract:
One-hundred-and-thirty-six children below 12 years of age hospitalized with a diagnosis of tuberculous meningitis (TBM) have been investigated to identify the underlying cause of convulsions. One-hundred-and-one children (74 per cent) presented with seizures before and/or during hospitalization. Generalized tonic and clonic seizures (GTCS) were the commonest (58 per cent) type of seizures followed by focal seizures (FS) (38 per cent) and tonic spasms (TS) (4 per cent). EEG changes were more frequently observed in cases with FS and in those children with GTCS who presented after first week of hospitalization. EEG findings included generalized dysrythmia with paroxysmal slow activity (38 per cent), interhemispheric asymmetry (23 per cent), multiple spike and wave pattern (10 per cent), and focal spike and wave pattern (15 per cent). CT scan findings were more common in those children with GTCS and TS who presented with recurrent seizures and/or seizures manifesting after first week of hospitalization. FS presenting at any stage of the disease were associated with CT scan abnormalities. Abnormalities detected in CT scan of brain included meningeal enhancement (55 per cent), hydrocephalus (32 per cent), tuberculomas (27 per cent), and cerebral infarctions (13 per cent). Clinical presentation and investigations indicate that the probable cause of convulsions could be attributed to cerebral edema (57 per cent), syndrome of inappropriate secretion of antidiuretic hormone (35 per cent), hydrocephalus (32 per cent), tuberculoma (27 per cent), abnormal electric focus (25 per cent), and cerebral infarction (13 per cent).