Clinical Analysis Of Purulent Meningitis In Children With Acute Seizures

Objective: Summarize the clinical characteristics of purulent meningitis in children with acute seizures,to explore the risk factors for secondary epilepsy and poor prognosis in children with purulent meningitis.Methods: Collect the clinical information of purulent meningitis with acute seizures in 131 children admitted to Children's Hospital of Chongqing Medical University,from February 2014 to January 2017,and summarize the characteristics of clinical manifestations and auxiliary examinations.Assess the prognosis by telephone or outpatient follow-up to analysis the risk factors which related with secondary epilepsy and poor outcome.Results:1.A total of 131 cases of purulent meningitis with acute seizures were enrolled in our study,and the proportion is 41.3% of children with purulent meningitis in the same period.The sex ratio was 1.43:1 for males andfemales,and the peak period for purulent meningitis with acute seizures is in infancy.There are many incentives causes,the most common one is respiratory tract infection.2.Fever,vomit,disturbance of consciousness,and positive neck resistance are the common clinical features.In infants,increased frontal expansion,irritability is more common.21 cases of Blood cultures or CSF cultures were positive,in which S.pneumoniae is the most common pathogens.3.The seizure types of acute seizures in purulent meningitis include Focal seizures and Generalized seizures.There are 42 cases having focal seizures,in which focal clonic seizures is more common.There are 100 cases having generalized seizures,in which generalized tonic-clonic seizures and generalized tonic seizures accounted for 46 cases respectively.The seizure types of 7 cases are unknown.19.8% cases have two seizure types.4 cases appear autonomic seizures.The frequency of acute seizure in59 cases < 3 times,while 72 cases ? 3 times.The duration of actue seizures in 95 cases(95/124,76.6%)are ? 5 minutes,which in 15 cases(15/124,12.1%)are 5 to 30 minutes,and epileptic status are found in 14 cases(14/124,11.3%).4.114 patients have EEG examination at acute phase.47(41.2%)are normal,but 67(58.8%)are abnormal.In interictal EEG,epileptic discharges were found in 32 cases(28.1%),background slowing in 32 cases(28.1%),rhythm change in 1 cases(0.9%),low voltage in 5 cases(4.4%).Ictal discharges were found in 5 cases(4.4%).Focal motor seizures are found in11 times,in which focal to bilateral tonic-clonic seizure could be seen.In ictal EEG,the common type is focal epileptic discharges,only one's origin is unknown.The origin of subclinical epileptiform discharges are Focal epileptic discharge for more than 20 times.5.123 cases with acute seizures accepted midazolam,phenobarbital,or chloral hydrate to control seizures.Antiepileptic drugs(AEDs)were used in 26 cases who have frequent seizures during the acute phase of purulent meningitis.11 cases are loss to follow-up.10 cases stop AEDs in 3to 12 months after onset for seizure free,while 5 cases developed secondary epilepsy and accept long-term AEDs.The total cases developed secondary epilepsy is 6(8.1%)when follow-up with 74 cases.By multivariate Logistic regression analysis,two independent risk factors which probably related to secondary epilepsy are found: one is interictal EEG which shows diffuse slow waves;and another one is the interval time(>4 days)between the onset of seizures to the onset of purulent meningitis6.According to Glasgow clinical outcome score,two groups are divided,one is the favourable prognosis group,which have 48 cases(62.3%),another one is the poor prognosis group,which have 29 cases(37.7%).In the poor prognosis group,3 cases died,6 cases developed secondary epilepsy,3 cases have mental retardation,10 cases havelanguage development disorders,3 cases have movement disorders,and 2cases have hydrocephalus,3 cases have hearing loss,8 cases have complete developmental retardation.Multivariate logistic regression analysis showed that frontal pretension/tension,abnormal EEG,and long duration of anti-infection treatment may be independent risk factors for poor prognosis(P< 0.05),and after drawing the ROC curve between the total anti-infection treatment course and prognosis,the threshold is ? 25 days.Conclusion:1.Acute seizures are one of the common symptoms of purulent meningitis in children.The seizure type are varied,generalized seizures are the most common type,and EEG abnormalities are found in more than half cases.In interictal EEG,we can see the diffuse slow wave of EEG background?epileptic discharge?low voltage,and so on.In ictal EEG or subclinical epileptiform discharge,the most common onset is focal discharges.2.Prevalence of epilepsy secondary to purulent meningitis with acute seizures is low.Interictal EEG which shows diffuse slow waves and the interval time(>4 days)between the onset of seizures to the onset of purulent meningitis are independent factors which probably related to secondary epilepsy.AEDs could be used only for children with frequent acute seizures;while long-term,regular,and rational use of AEDs are recommended for the patients with purulent meningitis who have recurrentseizures or subclinical epileptiform discharge after 6 months of onset.3.Purulent meningitis with acute seizures may have high incidence of poor sequelae and develop multiple sequelae,such as epilepsy,mental retardation,language development disorders,movement disorders,hearing loss,and complete developmental retardation.Frontal pretension/tension,abnormal EEG,and long duration of anti-infection treatment(?25 days)may be independent risk factors for poor prognosis(P< 0.05).