Application of transcranial direct current stimulation in refractory seizures in tuberculous meningitis: a case report

Tuberculous meningitis (TBM) is a devastating form of tuberculosis with high mortality and long-term neurological sequelae. Seizures, including refractory status epilepticus, are common complications and portend a poor prognosis. While neuromodulation techniques such as vagus nerve and deep brain stimulation have been used in refractory epilepsy, there are no prior reports of transcranial direct current stimulation (tDCS) in refractory seizures related to TBM. We report a 19-year-old woman with pulmonary tuberculosis who developed TBM with multiple central nervous system tuberculomas and refractory status epilepticus unresponsive to multiple antiseizure medications, intravenous anesthetics, and steroids. A structured course of cathodal tDCS was initiated (10 sessions, once daily for 10 days, 2 mA amplitude, 20 minutes per session, ramp-up 10 seconds, impedance 4 kΩ; cathode over electroencephalogram-localized epileptic focus, anode over contralateral supraorbital region). Following the intervention, sedation was successfully tapered, and the patient was discharged seizure-free on oral therapy. At the 1-month follow-up, she remained seizure-free and demonstrated clinical improvement, with no new neurological deficits. This case demonstrates the feasibility and potential benefit of tDCS as an adjunctive therapy for refractory seizures in TBM. While causality could not be established, this is the first report of tDCS application in TBM-related seizures. Controlled studies with objective neurophysiological endpoints are warranted.