The clinical data of 116 patients, 1 month to <5 years of age, admitted for bacterial meningitis, and grouped according to those with and without seizures during hospitalization, were compared in a study at Buddhist Dalin Tzu Chi General Hospital, Chang Gung Memorial Hospital and other centers in Taiwan. Fifty-five (47%) had seizures in the acute phase, especially prevalent in the older infants, and 12 of these had one or more afebrile seizures after completing treatment for acute meningitis. Seizures occurring 2 weeks after treatment were associated with hydrocephalus, subdural empyema, or cerebral infarction. Seizure prevalence was high in meningitis caused by E coli, Salmonella species, S agalactiae, Hemophilus species, and N meningitides. At 1-year follow-up, 26 had good outcomes and in 29 the outcome was poor. In those who had seizures in the acute phase, the outcome was worse than those without. Neuroimaging abnormalities correlated with the occurrence of seizures during hospitalization for meningitis. Factors that increased the risk of seizures included disturbed consciousness on admission, abnormal neuroimaging, and low glucose and elevated CSF protein. [1]

COMMENT. Seizures are common during hospitalization in the child with bacterial meningitis, and the occurrence of seizures during the acute phase is strongly correlated with late seizures, especially during the first 5 years of follow-up. Treatment of neurologic complications and aggressive antimicrobial therapy are essential for optimal outcome.

Afebrile seizures provoked by minor infections carry a 5.7% risk of subsequent unprovoked afebrile seizures by 5 year follow-up in a study at National Neuroscience Institute, Singapore. [2]