Abstract
Introduction
Despite the dramatic decrease of mortality rate among children with bacterial meningitis in recent decades, some patients are left with neurologic sequelae. The purpose of this study was to analyze the occurrence of seizures as predictors for meningitis-related deaths or neurological sequelae including late seizures.
Methods
This study uses a retrospective chart review of 277 children (aged 0–16 years, median 2 years, 162 boys) treated for bacterial meningitis in University Clinical Centre in Prishtina (Kosovo).
Results
Of the 277 children treated for bacterial meningitis, 60 children (22%) manifested seizures prior to admission, 57 children (21%) had seizures after admission, and late seizures were diagnosed in 24 children (9%). The risk for adverse outcome was significantly higher in patients who had seizures prior to admission (52/60) and in patients who manifested seizures later than 24 h (41/41; RR 8.17 and 6.78 respectively, p < 0.0001). All children who manifested late seizures were diagnosed with meningitis-related acute neurologic complications: subdural effusion (18), hydrocephalus (6), intracranial bleeding (1), and subdural empyema (2). Of the 60 children who presented seizures prior to admission, only 11 manifested late seizures.
Conclusions
Seizures prior to admission were predictors of high risk of adverse outcome in bacterial meningitis in children. The risk of secondary epilepsy (9%) occurred only in children with evident structural neurologic complications during the acute phase of bacterial meningitis.
Similar content being viewed by others
References
Chávez-Bueno S, McCracken GH Jr (2005) Bacterial meningitis in children. Pediatr Clin North Am 52:795–810
Durand ML, Calderwood SB, Weber DJ, Miller SI (1993) Acute bacterial meningitis in adults. A review of 493 episodes. N Eng J Med 328(1):21–28
Kaplan SL, Woods C (1992) Neurologic complications of bacterial meningitis in children. Curr Clin Top Infect Dis 12:37
McIntyre PB, MacIntyre CR, Gilmour R, Wang H (2005) A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis. Arch Dis Child 90:391–396
Østergaard C, Konradsen HB, Samuelsson S (2005) Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect Dis 5:93
Quagliarello VJ, Scheld WM (1997) Treatment of bacterial meningitis. N Eng J Med 336:708–716
Sáez-Llorens X, McCracken GH Jr (2003) Bacterial meningitis in children. Lancet 361:2139–2148
Schuchat A, Robinson K, Wenger JD, Harrison LH et al (1997) Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 337:970–976
van de Beek D, de Gans J, Spanjaard L, Weisfelt M et al (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351:1849–1859
Pfister HW, Feiden W, Einhaupl KM (1993) Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 50:575–581
Aronin SI, Peduzzi P, Quagliarello VJ (1998) Community-acquired bacterial meningitis; risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 129:862–869
World Health Organization (1998) Emerging and other communicable diseases surveillance and control. Control of epidemic meningococcal disease. WHO practical guidelines Geneva 2nd ed
Pasquale P, Ugo F, Vittorio A, Marco R et al (2007) Pneumococcal meningitis in childhood: a longitudinal prospective study. FEMS Immunol Med Microbiol 8:488–495
Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD (1990) Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 323:1651
Baraff LJ, Lee SI, Schriger DL (1993) Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J 12:389–394
Grimwood K, Nolan TM, Bond L, Anderson VA et al (1996) Risk factors for adverse outcomes of bacterial meningitis. J Paediatr Child Health 32:457–462
Akpede GO, Akuhwa RT, Ogiji EO, Ambe JP (1999) Risk factors for an adverse outcome in bacterial meningitis in the tropics: a reappraisal with focus on the significance and risk of seizures. Ann Trop Paediatr 19:151–159
Chang CJ, Chang WN, Huang LT, Huang SC et al (2004) Seizures complicating infantile and childhood bacterial meningitis. Pediatr Neurol 31(3):165–171
Rosman NP, Peterson DB, Kaye EM, Colton T (1985) Seizures in bacterial meningitis: prevalence, patterns, pathogenesis, and prognosis. Pediatr Neurol 1(5):278–285
McCarthy PL, Sharpe MR, Spiesl SZ et al (1982) Observation scales to identify serious illness in febrile children. Pediatrics 70:802–809
Dodge PR, Swartz MN (1965) Bacterial meningitis—a review of selected aspects. II. Special neurologic problems, postmeningitic complications and clinicopathological correlations. N Engl J Med 272:954–1010
Klinger G, Chin CN, Beyene J, Perlman M (2000) Predicting the outcome of neonatal bacterial meningitis. Pediatr 106:477–482
De Jonge RCJ, van Furth AM, Wassennar M, Gemke RJBJ et al (2010) Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies. BMC Infect Dis. doi:10.1186/1471-2334-10-232
Competing interests
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Namani, S.A., Kuchar, E., Koci, R. et al. Early symptomatic and late seizures in Kosovar children with bacterial meningitis. Childs Nerv Syst 27, 1967–1971 (2011). https://doi.org/10.1007/s00381-011-1480-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-011-1480-3