Misra Usha K, Kumar Mritunjai, Kalita Jayantee
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Epilepsy Res. 2018 Dec;148:90-95. doi: 10.1016/j.eplepsyres.2018.10.005. Epub 2018 Oct 25.
We report the frequency of seizure, its possible mechanisms and effect of seizure on the outcome of tuberculous meningitis (TBM).
Seventy-nine patients with TBM admitted during 2014-2017 were evaluated. The seizures were categorized as per International League Against Epilepsy as well as into early (within 1 month of meningitis) and late (>1 month) seizure. The possible association of seizures was recorded and the outcome was assessed using modified Rankin Scale (mRS ≤ 2 as good, and mRS > 2 as poor).
The median age was 27 (18-76) years and 43 (54.4%) of whom were females. Tuberculous meningitis was definite in 31 (39.2%) and highly probable in the remaining. Seizures occurred in 27 (34.2%): early onset in 8 (29.6%) and late in 19 (70.4%) patients. The seizures were focal in 11(13.9%), focal to bilateral in 9 (11.4%), generalised tonic clonic in 7 (8.9%) and status epilepticus in 6 (7.6%) patients. Early seizures were associated with meningeal irritation and late seizures with tuberculoma, infarction and hyponatremia (P = 0.01). Seizure did not affect the mortality but were associated with worse six months outcome (P = 0.03).
Seizures occurred in 34% patients with TBM and were associated with poor outcome at six months.
我们报告结核性脑膜炎（TBM）患者癫痫发作的频率、可能机制及其对预后的影响。
对2014年至2017年收治的79例TBM患者进行评估。癫痫发作根据国际抗癫痫联盟进行分类，并分为早期（脑膜炎1个月内）和晚期（>1个月）发作。记录癫痫发作的可能关联因素，并使用改良Rankin量表评估预后（mRS≤2为良好，mRS>2为不良）。
中位年龄为27（18 - 76）岁，其中43例（54.4%）为女性。31例（39.2%）确诊为结核性脑膜炎，其余高度疑似。27例（34.2%）出现癫痫发作：8例（29.6%）为早期发作，19例（70.4%）为晚期发作。11例（13.9%）癫痫发作为局灶性，9例（11.4%）为从局灶性发展为双侧性，7例（8.9%）为全身强直阵挛发作，6例（7.6%）为癫痫持续状态。早期癫痫发作与脑膜刺激有关，晚期癫痫发作与结核瘤、梗死和低钠血症有关（P = 0.01）。癫痫发作不影响死亡率，但与6个月时较差的预后相关（P = 0.03）。
34%的TBM患者出现癫痫发作，且与6个月时的不良预后相关。
