Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis

Abstract

BACKGROUNDTuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM.

The prevalence, characteristics and outcome of seizure in tuberculous meningitis

“…Focal spikes on EEG are more often associated with brain abnormalities that may induce recurrent seizures and chronic epilepsy [4]. Gunawan et al have found a strong correlation between clinical seizures and EEG abnormalities; this study has also reported that EEG can be used to detect seizure activity and assess the risk of epilepsy in patients with TBM [30]. Therefore, a severe and persistent epileptic activity on EEG may predict recurrent seizures and chronic epilepsy.…”

“…This study has also suggested that the presence of epileptiform discharges on EEG may predict chronic epilepsy [4]. Gunawan and colleagues have reported abnormal EEG activity in 75% of the patients, out of them 77% had epileptogenic activities; moreover, they found a strong correlation between epileptic spikes on EEG and the development of clinical seizures [30]. However, a recent study from China has concluded that the presence of epileptiform discharge on EEG was not associated with poorer outcome [75].…”

“…Although Kalita J. et al has reported clinical seizures in 11 adult patients with TBM, epileptiform activity was noted in only 4 patients [67]. EEG is often more sensitive in children than adults; In a study included 12 children with TBM, epileptic activity was detected in 8 out of the 10 (83.3%) children presented with clinical seizures [30]. It is also worth mentioning that EEG recording in TBM patients with non-convulsive SE often shows continuous rhythmic activity.…”

“…Children with TBM are more likely to experience seizures relative to adults; this may be attributed to the immaturity of CNS, blood-brain barrier, and the immune system of this vulnerable group [4,26]. The incidence of seizures in children with TBM has been estimated between 50 and 74% [4,[26][27][28][29]; with higher rates being reported in pediatric patients under the age of 4 years [30][31][32][33]. While the reported risk of late unprovoked seizures among CNS infection survivors in the developed countries is estimated at 6.8-8.3%, it is much higher in resource-poor countries [34].…”

“…EEG can be used to detect the underlying seizure activity and predict the risk of secondary epilepsy in patients with TBM [4,30]. Moreover, EEG may help to localize the underlying lesions, exclude non-convulsive SE, and provide a rough guide to the degree of cortical and subcortical dysfunction in TBM patients [76,77].…”