Abstract:

Objective: To analyze the clinical features and influencing factors of epilepsy secondary to tuberculous meningitis (TBM) in children. Methods: One hundred and thirty-six children diagnosed with TBM during Jan. 2018 to Jan. 2022 in Changsha Central Hospital Affiliated to the University of South China were enrolled for retrospective analysis. Univariate and multivariate logistic regression models were used to analyze the influence of clinical characteristics on secondary epilepsy in children with TBM. Results: Among 136 children with TBM, 20 (14.7%) had secondary epilepsy. Univariate analysis showed that focal symptoms in the nervous system (30.0% (6/20)), changes in consciousness (65.0% (13/20)), hydrocephalus(50.0% (10/20)), cerebral infarction (30.0% (6/20)), accompanied by tuberculoma (10.0% (2/20)), TBM phase Ⅲ (50.0% (10/20)), cerebrospinal fluid protein (1.66 (0.02, 5.60) g/L), cerebrospinal fluid adenosine deaminase (ADA)(12.74 (1.22, 63.50) U/L), blood sodium ((127.35±3.73) mmol/L) in children with secondary epilepsy were significant different from that in children without secondary epilepsy (6.9% (8/116), 30.2% (35/116), 17.2% (20/116), 9.5% (11/116), 1.7% (2/116), 11.2% (13/116), 1.01 (0.02, 5.60) g/L, 3.79 (0.00, 94.00) U/L and (132.91±5.40) mmol/L)(χ²=9.860, P=0.007; χ²=9.060, P=0.004; χ²=13.820, P=0.001; χ²=6.566, P=0.021; χ²=13.511, P=0.004; χ²=19.478, P=0.000; Z=-2.120, P=0.034; Z=-5.005, P=0.000; t=-4.424, P=0.000). Multivariate logistic regression analysis showed that cerebral infarction (OR (95%CI)=4.397 (1.152-5.837), P=0.014), increased ADA in cerebrospinal fluid (OR (95%CI)=1.044 (1.021-1.297), P=0.033), and hyponatremia (OR (95%CI)=0.814 (0.672-0.909), P=0.003) were risk factors for secondary epilepsy to TBM. Conclusion: The proportion of secondary epilepsy in children with TBM is high, which should be paid great attention in clinic. The occurrence of cerebral infarction, increase of ADA in cerebrospinal fluid and hyponatremia may be important early predictive indicators of secondary epilepsy in children with TBM. Active and standardized anti-epileptic treatment has certain value in controlling secondary epilepsy.

Key words: Tuberculosis, meningeal, Child, Epilepsy, Factor analysis, statistical