Profi le and Predictors of new onset acute symptomatic seizures following community acquired acute bacterial meningitis

Introduction: Studies regarding acute symptomatic seizures in patients with acute bacterial meningitis are few. We analyzed the incidence and details of new-onset acute symptomatic seizures in patients with ‘etiology proven acute bacterial meningitis’. Methods: This retrospective cross-sectional study involved 47 patients with community-acquired confi rmed acute bacterial meningitis who manifested with new-onset acute symptomatic seizures among 191 patients with acute bacterial meningitis evaluated from 1999 to 2008 at NIMHANS, Bangalore. The clinical, CT scan and laboratory data patient groups with and without seizures were compared using appropriate statistical tool. Results: Forty-seven patients (24.4%; M:F=36:10) with mean age of 20.32±19.48 years had new-onset acute symptomatic seizures. Status epilepticus was noted in 8 while cluster attacks were present in 7 patients. The causative agents included pneumococcal 28 (59.6%), meningococcal 3 (6.4%), H. infl uenzae b -10 (21.3%) and others 5 (12.8%). CT scan (brain) was abnormal in 72.3% and included diffuse edema (23.4%), and focal hypodensities (14.9%). Patients with seizures were signifi cantly younger (<0.05), more often had abnormal brain imaging (p<0.005), and pneumococcal meningitis and H. infl uenzae type b meningitis (P<0.001) as compared to those without seizures. There was no other signifi cant difference in clinical and laboratory parameters between the two groups. Treatment with adjunctive steroid was not associated with any reduction in acute symptomatic seizures. Majority received parenteral phenytoin (n=40) followed by sodium valproate (n=4) and phenobarbitone (n=3). Conclusions: New-onset acute symptomatic seizures were noted in 24.4% of patients with etiologically proven community acquired acute bacterial meningitis. The occurrence of remote symptomatic seizures in these patients with acute bacterial meningitis needs to be studied. Neurology Asia 2011; 16(4) : 291 – 298 Address correspondence to: Dr. Sanjib Sinha, MD, DM, Additional Professor of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Hosur Road, Bangalore – 560029, India. Fax: +91 8