Prevalence of Seizures in Patients With Tuberculous Meningitis (TBM) and Their Clinical Outcomes

Background The diagnosis of tuberculous meningitis (TBM) is challenging, as it requires a high level of clinical suspicion and robust efforts to manage complications. Aim The study focussed on the early detection of seizures and their functional and final outcome with etiological workup radiologically and on lab investigations. Design and methods This was a prospective observational study, in which 100 suspected TBM patients were enrolled based on Lancet consensus criteria at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, from August 2022 to December 2023. Patient's clinical characteristics, TBM severity assessment, CSF analysis, cerebral imaging, and EEG were done. The modified Rankin Score (mRS) assessed clinical outcomes. Results The patients' mean age was 36.12 years, with the majority comprising the female gender (55%). Among the clinical presentations, the most common were fever (88; 88%), headache (60; 60%), altered mental status (AMS) (84; 84%), and seizures on presentation (29; 29%). Of the patients with seizures, 72.4% presented with altered mental status with a p-value of 0.043. Based on the severity of the presentation, 44 (44%) presented in stage II, 35 (35%) presented in clinical stage III, and the rest (21; 21%) in stage I. The GeneXpert Ultra test was positive in 50 (50%) patients for a definitive diagnosis of tuberculous meningitis. On MRI brain, infarcts (42; 42%); hydrocephalus (32; 32%), tuberculomas (31; 31%), and exudates (13; 13%) were seen in patients. Cerebral vasculitic infarcts were found to be an independent predictor of seizures (p 0.01). Out of 29 patients with seizures, 14 patients had an mRS score of 6 and 7 patients had an mRS score of <= 2 at the end of 3 months. Conclusion Vasculitic infarcts in TBM were strongly associated with seizure occurrence.