New-onset seizures in adults with tuberculous meningitis during long-term follow-up: Characteristics, functional outcomes and risk factors. (April 2020)

• Record Type: Journal Article
• Authors: Song, Xiaosong; Wen, Lan; Li, Maolin; Yu, Xinyuan; Wang, Lijun; Li, Kunyi
• Is Part Of: International journal of infectious diseases. Volume 93(2020)
• Page Start: 258
• Page End: 263
• Publication Date: 2020-04
• Subjects: Seizure -- Tuberculous meningitis -- Adult -- Risk factor -- Functional outcome; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.02.007
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Seizure is a common complication of tuberculous meningitis (TBM), but few studies have focused on this condition in this population. We performed this retrospective study to summarize the characteristics of and risk factors in adult seizure patients during long-term follow-up. Our study found that the incidence of seizures was 20% during follow-up. The most common frequency of seizures was repetitive, and the most common type of seizures was generalized. According to the frequency of seizures, non-single seizures (repetitive seizures and status epilepticus) were associated with poor functional outcomes, while single seizures were not. Based on multivariable analysis, the independent risk factors associated with non-single seizures were cerebral cortical involvement and epileptiform discharges. In patients who suffer from seizures for the first time and show findings of cortical involvement and epileptiform discharges, it may be beneficial to start AED treatment. Abstract: Objective: This study aimed to determine the characteristics and risk factors of adult new-onset seizure patients with tuberculous meningitis (TBM) during long-term follow-up. Methods: Patients with TBM who were seen between June 2012 and January 2018 were retrospectively reviewed and categorized into two groups based on the presence or absence of new-onset seizures. Seizure characteristics, functional outcomes and risk factors were assessed. Results: A total of 223 patients with TBM were enrolled, including 20.6% (46/223) with seizures. In all, 39.1% (18/46) of the patients with new-onset seizures and 14.1% (25/177) of the patients without seizures died (p < 0.001). Seizures were classified as single (n = 14/46, 30.4%), repetitive (n = 25/46, 54.3%), or status epilepticus (n = 7/46, 15.2%). We found that non-single seizures (repetitive seizures and status epilepticus) were associated with mortality (P = 0.002, P = 0.022), while single seizures were not (P = 0.834). The independent risk factors associated with non-single seizures were cortical involvement (p = 0.007) and epileptiform discharges (p = 0.001). Conclusions: Non-single seizures were associated with poor functional outcomes and should be noted by the clinic. Cortical involvement and epileptiform discharges are independent risk factors for non-single seizures.