Occurrence and determinants of seizures and their impact on tuberculous meningitis: a prospective evaluation.

Autor: Kirar RS; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Uniyal R; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India. ravi.sun.uniyal@gmail.com., Garg RK; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Verma R; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Malhotra HS; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Sharma PK; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Kumar N; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Pandey S; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Rizvi I; Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India., Jain A; Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, 22600, India.
Jazyk: angličtina
Zdroj: Acta neurologica Belgica [Acta Neurol Belg] 2024 Jun; Vol. 124 (3), pp. 821-829. Date of Electronic Publication: 2024 Jan 02.
DOI: 10.1007/s13760-023-02444-2
Abstrakt: Objective: To assess the incidence of seizures and the factors contributing to poor outcomes in patients with tuberculous meningitis (TBM).
Methods: In this prospective observational study, 129 patients with TBM were enrolled at the Department of Neurology, King George's Medical University, Uttar Pradesh, India, from April 2021 to April 2023. Detailed clinical history, neurological examinations, baseline laboratory tests, contrast-enhanced Magnetic resonance imaging (MRI) and electroencephalography (EEG) were obtained for all patients. Patients received anti-tuberculous therapy and, if necessary, anti-epileptic treatment. Patients were followed for 6 months, with outcomes evaluated using the Modified Rankin Scale (MRS).
Results: Of the 129 patients, 48 (37.2%) reported seizures. Advanced TBM stage (p = 0.040, OR = 2.50 95% CI:1.02-6.07), cortical involvement (p = .0.013, OR = 2.58 95% CI:1.20-5.51) and spike-wave discharges in the EEG (p = 0.001) were significantly associated with seizure occurrence. After multivariate analysis, only cortical involvement (p = 0.031, OR = 2.34, 95% CI:1.08-5.08) emerged as independent predictor of for seizures. Focal to bilateral seizures (p = 0.008, OR = 9.41, 95% CI: 1.76-74.04), status epilepticus (p = 0.002, OR = 8.00, 95% CI: 1.86-34.32), and rifampicin resistance (p = 0.022, OR = 9.25, 95% CI: 1.43-59.50) were significantly associated with poor outcomes at the 6-month mark.
Conclusion: Seizures were significantly associated with advanced stage of the disease, cortical involvement on neuro-imaging and epileptiform pattern on EEG. Additionally, focal to bilateral seizures and status epilepticus adversely affected the outcome.
(© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)
Databáze: MEDLINE
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