Pomeroy S L, Holmes S J, Dodge P R, Feigin R D
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
N Engl J Med. 1990 Dec 13;323(24):1651-7. doi: 10.1056/NEJM199012133232402.
Although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades, some patients are left with neurologic sequelae. It has not been clearly established which features of the acute illness predict the chronic neurologic sequelae, including late seizures or epilepsy.
We followed 185 infants and children prospectively during and after acute bacterial meningitis. The mean duration of follow-up was 8.9 years (range, 0.1 to 15.5). During the first six years standard neurologic examinations were performed; telephone interviews were conducted thereafter.
One month after meningitis, 69 children (37 percent) had neurologic abnormalities. Many of these signs resolved within a year, leaving only 26 children (14 percent) with persistent deficits: 18 (10 percent) had only sensorineural hearing loss, and 8 (4 percent) had multiple neurologic deficits. Thirteen children (7 percent) had one or more late seizures not associated with fever. The presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures (P less than 0.001).
After bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy. Those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae, including epilepsy.
尽管近几十年来细菌性脑膜炎患儿的死亡率已大幅下降，但仍有部分患者遗留神经后遗症。急性疾病的哪些特征可预测慢性神经后遗症，包括迟发性癫痫发作或癫痫，目前尚未明确。
我们对185例急性细菌性脑膜炎患儿在患病期间及病后进行了前瞻性随访。平均随访时间为8.9年（范围0.1至15.5年）。在最初六年内进行标准神经学检查；此后通过电话进行随访。
脑膜炎发病后1个月，69例患儿（37%）存在神经异常。其中许多体征在1年内消失，仅有26例患儿（14%）遗留持续性缺陷：18例（10%）仅有感音神经性听力损失，8例（4%）有多种神经缺陷。13例患儿（7%）出现1次或多次与发热无关的迟发性癫痫发作。提示脑损伤的持续性神经缺陷是迟发性无热惊厥的唯一独立预测因素（P<0.001）。
细菌性脑膜炎后，仅有遗留永久性神经缺陷的患儿癫痫风险高。急性疾病后检查正常者发生严重神经后遗症（包括癫痫）的可能性极小。
