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From the Department of Neurology (E.Z., M.W., J.d.G., J.H.T.M.K., D.v.d.B.), Department of Medical Microbiology (L.S.), The Netherlands Reference Laboratory for Bacterial Meningitis (L.S.), Department of Clinical Neurophysiology (J.H.T.M.K.), and Department of Clinical Epidemiology, Biostatistics and Bioinformatics (J.B.R.), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands.
Address correspondence and reprint requests to Dr. Diederik van de Beek, Department of Neurology, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands D.vandebeek{at}amc.uva.nl
Objective: To evaluate the occurrence and prognostic relevance of seizures in adults with community-acquired bacterial meningitis.
Methods: An observational cross-sectional study, in which patients with seizures are selected from a prospective nationwide cohort of 696 episodes of community-acquired bacterial meningitis, confirmed by culture of CSF in patients aged >16 years. We retrospectively collected data on EEGs.
Results: Seizures occurred in 121 of 696 episodes (17%). Death occurred in 41% of patients with seizures compared to 16% of patients without seizures (p < 0.001). The median number of seizures was 2 (interquartile range [IQR] 1 to 4). The median time between admission and the first seizure was 1 day (IQR 0 to 3). Patients with in-hospital seizures were more likely to have a CSF leukocyte count below 1,000 cells/mm3 (36% vs 25%; p = 0.01), had higher median CSF protein levels (4.8 g/L [IQR 3.4 to 7.6] vs 4.1 g/L [IQR 2.1 to 6.8]), and higher median erythrocyte sedimentation rate (46 mm/hour [IQR 31 to 72] vs 36 mm/hour [IQR 18 to 69]; p = 0.02) than patients without in-hospital seizures. Focal cerebral abnormalities developed more often in patients with in-hospital seizures than in those without (41% vs 14%; p < 0.001). In a multivariate analysis, seizures were significantly more likely in patients with predisposing conditions, tachycardia, a low Glasgow Coma Scale score on admission, infection with Streptococcus pneumoniae, and focal cerebral abnormalities. Neuroimaging was performed on admission in 70% of episodes with prehospital seizures, with CT revealing a focal lesion in 32% of those episodes. Antiepileptic drugs were administered in 82% of patients with seizures and EEG was performed in 31% of episodes; a status epilepticus was recorded in five patients.
Conclusions: Seizures occur frequently in adults with community-acquired bacterial meningitis. Seizures are associated with severe CNS and systemic inflammation, structural CNS lesions, pneumococcal meningitis, and predisposing conditions. The high associated mortality rate warrants a low threshold for starting anticonvulsant therapy in those with clinical suspicion of a seizure.
Abbreviations: GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; IQR = interquartile range.
Supplemental data at www.neurology.org
Editorial, page 2095
e-Pub ahead of print on February 27, 2008, at www.neurology.org.
Disclosure: The authors report no conflicts of interest.
Received May 23, 2007. Accepted in final form August 8, 2007.
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  K. L. Tyler Bacterial meningitis: An urgent need for further progress to reduce mortality and morbidity Neurology, May 27, 2008; 70(22_Part_2): 2095 - 2096. [Full Text] [PDF]
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