Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis

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Prastiya Indra Gunawan
Darto Saharso


Tuberculous meningitis (TBM) is a severe intracranial infection with fatal outcomes, permanent disabilities, and electroencephalographic (EEG) abnormalities. Seizures may occur in TBM. The EEG findings in TBM vary according to the site of the inflammatory process. There are few studies describing the EEG patterns and clinical manifestations of TBM. The objective of this study was to investigate the correlation between clinical findings and EEG patterns in children with TBM.

A study of cross-sectional design using medical records was conducted on 12 children with TBM, with their EEG patterns classified as abnormal and normal. Clinical manifestations such as seizures, altered consciousness, headache or fever were collected. A positive cerebrospinal fluids Mycobacterium tuberculosis culture was considered to indicate definitive TBM. Abnormal EEG descriptions were classified into abnormal I, II or III. Correlation between EEG pattern and clinical manifestation were analyzed with Fisher’s exact test.

The study found cases of 12 children with TBM, the majority presenting with seizures, decreased consciousness and fever. Abnormal EEGs were found in 75% of children and 77% of them showed epileptogenic activities. The EEG results mostly described epileptogenic potentials in the frontotemporal region. There was a significant correlation between EEG abnormality and seizures in children with TBM (p<0.05).

The EEG pattern in children with TBM varies, and EEG abnormalities were more frequently localized in the frontotemporal region. Seizures were associated with EEG abnormalities in children with TBM. EEG abnormalities occurring simultaneously with seizures may predict the occurrence of seizures.

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Gunawan, P. I., & Saharso, D. (2015). Seizure increases electroencephalographic abnormalities in children with tuberculous meningitis. Universa Medicina, 34(3), 161–167.
Review Article


Philip N, William T, Vanitha D. Diagnosis of tuberculous meningitis: challenges and promises. Malaysian J Pathol 2015;37:1-9.

Murthy JM. Management of intracranial pressure in tuberculous meningitis. Neurocrit Care 2005;2:306-12.

Paganini H, Gonzalez F, Santander C, et al. Tuberculous meningitis in children: clinical features and outcome in 40 cases. Scand J Infect Dis 2000;32:41-5.

Wu XR, Yin QQ, Jiao AX, et al. Pediatric tuberculosis at Beijing Children’s Hospital: 2002–2010. Pediatr 2012;130:e1433-40.

Anderson NE, Somaratne J, Mason DF, et al. Neurological and systemic complications of tuberculous meningitis and its treatment at Auckland City Hospital, New Zealand. J Clin Neurosci 2010;17:1114–8.

Brigo F, Ausserer H, Zuccoli G, et al. Seizure heralding tuberculous meningitis. Epileptic Disord 2012;14:329-33.

Miftode EG, Dorneanu OS, Leca DA, et al. Tuberculous meningitis in children and adults: A 10-year retrospective comparative analysis. Plos One 2015;10:e0133477.

Smith SJM. EEG in the diagnosis, classification, and management of patient with epilepsy. J Neurol Neurosurg Psychiatry 2005;76 Suppl II:ii2–ii7.

Luders H, Noachtar S. Atlas and classification of electroencephalography. Philadelphia: Saunders;2006.

Park S, Hong YJ, Lee MK, et al. Hippocampal sclerosis and encephalomalacia as prognostic factors of tuberculous meningitis-related and herpes simplex encephalitis-related epilepsy. Seizure 2011;20:570-4.

Kaplan PW. The EEG in metabolic encephalopathy and coma. J Clin Neurophysiol 2004;21:307-18.

Ikeda A, Klem GH, Luders HO. Metabolic, infectious and hereditary encephalopathies. In: Ebersole JS, Pedley TA, editors. Current practice of clinical electroencephalography. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2003.p.348-77.

Arman F, Kaya D, Akgün Y, et al. Tuberculous meningitis presenting with nonconvulsive status epilepticus. Epilepsy Behav 2011;20:111-5.

Kalita J, Misra UK, Das BK. SPECT changes and their correlation with EEG changes in tuberculous meningitis. Electromyogr Clin Neurophysiol 2002;42:39-44.

Choi J, Nordli DR, Alden TD, et al. Cellular injury and neuroinflammation in children with chronic intractable epilepsy. J Neuroinflammation 2009;6: 38.

van Well GTJ, Paes BF, Terwee CB, et al. Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the Western Cape of South Africa. Pediatr 2009;123:e1-8.

Alsemari A, Baz S, Alrabiah F, et al. Natural course of epilepsy concomitant with CNS tuberculomas. Epilepsy Res 2012;99:107-11.

Misra UK, Kalita J, Roy AK, et al. Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neurosurg Psychiatry 2000;68:300–3.

Ginsberg L, Desmond K. Chronic and recurrent meningitis. Practical Neurol 2008; 8:348-61.

Christie L, Loeffler AM, Honarmand S, et al. Diagnostic challenges of central nervous system tuberculosis. Emerg Infect Dis 2008;14:1474-5.