Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli, Road, Lucknow, Uttar Pradesh 226014, India.
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli, Road, Lucknow, Uttar Pradesh 226014, India.
Epilepsy Behav. 2024 Oct;159:109986. doi: 10.1016/j.yebeh.2024.109986. Epub 2024 Aug 24.
There is paucity of information about status epilepticus (SE) in tuberculous meningitis (TBM). In this communication, we report SE semiology, response to antiseizure medication (ASM) and outcome of the TBM patients with SE.
The diagnosis of TBM was based on clinical, cerebrospinal fluid and MRI findings. The clinical details, severity of meningitis, and MRI and electroencephalography findings were noted. The type of SE, onset from the meningitis symptoms, number of ASMs required to control SE and outcomes were noted.
During study period from august 2015 to march 2023, 143 TBM patients were admitted and 10 (6.9 %) had SE, whose age ranged between 12 and 45 years. MRI revealed exudates in six, hydrocephalus in three, infarctions in seven and tuberculoma in six patients. Median (interquartile range) duration of SE after meningitis symptoms was 65 (43.7-100.5) days. Three had generalized convulsive SE, three epileptia partialis continua (EPC), three focal convulsive SE with bilateral convulsion, and one had non-convulsive SE. Two (20 %) patients responded to two ASMs, six (60 %) had refractory SE whose seizure continued after benzodiazepine and one ASM, and two (20 %) had super-refractory SE having seizures for ≥ 24 h despite use of intravenous anesthetic agent. Four (40 %) patients died; uncontrolled SE resulted death in one, and the remaining patients died due to primary disease. Only 2 (20 %) patients had good recovery and 4 (40 %) had poor recovery at 6 months.
Status epilepticus in TBM is uncommon and can be refractory or super-refractory resulting in poor outcome.
有关结核性脑膜炎（TBM）中癫痫持续状态（SE）的信息很少。在本次交流中，我们报告了 SE 的症状、抗癫痫药物（ASM）反应和 SE 伴 TBM 患者的结局。
TBM 的诊断基于临床、脑脊液和 MRI 发现。记录了临床详细信息、脑膜炎严重程度、MRI 和脑电图发现。记录了 SE 的类型、从脑膜炎症状开始的时间、控制 SE 所需的 ASM 数量和结局。
在 2015 年 8 月至 2023 年 3 月期间的研究期间，共收治了 143 例 TBM 患者，其中 10 例（6.9%）患有 SE，年龄在 12 至 45 岁之间。MRI 显示 6 例有渗出物，3 例有脑积水，7 例有梗死，6 例有结核瘤。脑膜炎症状后 SE 的中位数（四分位距）持续时间为 65（43.7-100.5）天。3 例为全面性强直阵挛性 SE，3 例为部分性持续癫痫（EPC），3 例为局灶性强直阵挛性 SE 伴双侧抽搐，1 例为非惊厥性 SE。2（20%）例患者对 2 种 ASM 有反应，6（60%）例为难治性 SE，苯二氮䓬和 1 种 ASM 后癫痫发作持续，2（20%）例为超难治性 SE，即使使用静脉麻醉剂，癫痫发作仍持续≥24 小时。4（40%）例患者死亡；1 例因无法控制的 SE 导致死亡，其余患者因原发性疾病死亡。只有 2（20%）例患者在 6 个月时有良好恢复，4（40%）例有不良恢复。
TBM 中的 SE 并不常见，可能是难治性或超难治性的，导致预后不良。
