Guillem Lluïsa, Hernández-Pérez Guillermo, Berbel Damaris, Pelegrín Ivan, Falip Mercè, Cabellos Carmen
Department of Clinical Sciences, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain.
Department of Clinical Sciences, Neurology Service, Bellvitge University Hospital-Bellvitge Institute for Biomedical Research (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Spain.
Epilepsia Open. 2024 Dec;9(6):2319-2330. doi: 10.1002/epi4.13054. Epub 2024 Sep 30.
Our aim was to assess seizure development as a complication of pneumococcal meningitis and its possible prevention with antiseizure medication prophylaxis.
Antiseizure medication (ASM) prophylaxis has been practiced for a long time at our center. We assessed all cases of community-acquired pneumococcal meningitis admitted from January 2010 to April 2021 recorded in our prospective database and conducted further retrospective studies.
Of the 86 cases recorded, 21 (24.4%) developed acute symptomatic seizures, more than half of which (11/21; 52.4%) before admission. Seizure development increased the need for orotracheal intubation and intensive care unit admission, while also lengthening hospital stays and suggesting more risk of death and disability at discharge [adjusted odds ratio (aOR), 3.13; 95% confidence interval (CI): 1-9.8]. Of the 74 patients eligible for ASM prophylaxis, 64 received it and 10 did not. ASM prophylaxis seemed effective in preventing seizure development, as only six seizure events were recorded in 64 patients with ASM prophylaxis (9.4%) compared with four in the 10 patients without prophylaxis (40%). Its preventive capacity was especially notable when administered within 4 h of admission. Differences in mortality did not reach statistical significance. Adverse effects were rare.
Seizure development is a common complication in pneumococcal meningitis and is associated with increased risks of Intensive Care Unit admission, orotracheal intubation, and longer hospital stays. ASM prophylaxis may be effective in blocking seizure development in patients with preventable seizures and may be associated with better prognosis. Further studies are now warranted.
Infection of the meninges (the covering of the brain) due to the common bacteria S pneumoniae, used to be a fatal disease before the introduction of antibiotics and corticoids. Thanks to these drugs, more people survive this disease but, due to the frequent complications, they may have several sequelae. Seizures are a common complication. Our study suggests that they might be prevented by using antiseizure drugs which may reduce both severity and hospital stay.
我们的目的是评估癫痫发作作为肺炎球菌性脑膜炎并发症的发生情况，以及使用抗癫痫药物预防其发生的可能性。
我们中心长期采用抗癫痫药物（ASM）预防措施。我们评估了前瞻性数据库中记录的2010年1月至2021年4月期间收治的所有社区获得性肺炎球菌性脑膜炎病例，并进行了进一步的回顾性研究。
在记录的86例病例中，21例（24.4%）发生了急性症状性癫痫发作，其中一半以上（11/21；52.4%）在入院前发作。癫痫发作增加了气管插管和入住重症监护病房的需求，同时也延长了住院时间，并提示出院时死亡和残疾风险更高[调整优势比（aOR），3.13；95%置信区间（CI）：1-9.8]。在74例符合ASM预防条件的患者中，64例接受了预防，10例未接受。ASM预防似乎对预防癫痫发作有效，接受ASM预防的64例患者中仅记录到6次癫痫发作事件（9.4%），而未接受预防的10例患者中有4次（40%）。在入院后4小时内给药时，其预防能力尤为显著。死亡率差异无统计学意义。不良反应很少见。
癫痫发作是肺炎球菌性脑膜炎的常见并发症，与入住重症监护病房增加、气管插管和住院时间延长的风险相关。ASM预防可能有效阻止可预防性癫痫发作患者的癫痫发作，并可能与更好的预后相关。现在有必要进行进一步研究。
由常见细菌肺炎链球菌引起的脑膜（大脑的覆盖物）感染，在抗生素和皮质类固醇引入之前曾是一种致命疾病。由于这些药物，更多人在这种疾病中存活下来，但由于频繁的并发症，他们可能会有多种后遗症。癫痫发作是一种常见并发症。我们的研究表明，使用抗癫痫药物可能预防癫痫发作，这可能会降低严重程度并缩短住院时间。
