Dexamethasone and long-term outcome in adults with bacterial meningitis.
OBJECTIVE
This follow-up study of the European Dexamethasone Study was designed to examine the potential harmful effect of adjunctive dexamethasone treatment on long-term neuropsychological outcome in adults with bacterial meningitis.


METHODS
Neurological, audiological, and neuropsychological examinations were performed in adults who survived pneumococcal or meningococcal meningitis.


RESULTS
Eighty-seven of 99 (88%) eligible patients were included in the follow-up study; 46 (53%) were treated with dexamethasone and 41 (47%) with placebo. Median time between meningitis and testing was 99 months. Neuropsychological evaluation showed no significant differences between patients treated with dexamethasone and placebo. The proportions of patients with persisting neurological sequelae or hearing loss were similar in the dexamethasone and placebo groups. The overall rate of cognitive dysfunction did not differ significantly between patients and control subjects; however, patients after pneumococcal meningitis had a higher rate of cognitive dysfunction (21 vs 6%; p = 0.05) and experienced more impairment of everyday functioning due to physical problems (p = 0.05) than those after meningococcal meningitis.


CONCLUSIONS
Treatment with adjunctive dexamethasone is not associated with an increased risk for long-term cognitive impairment. Adults who survive pneumococcal meningitis are at significant risk for long-term neuropsychological abnormalities.
Weisfelt
Martijn
M
Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands. m.weisfelt@amc.uva.nl
Hoogman
Martine
M
van de Beek
Diederik
D
de Gans
Jan
J
Dreschler
Wouter A
WA
Schmand
Ben A
BA
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006320:Hearing Tests; D006801:Humans; D007361:Intelligence Tests; D007802:Language; D008297:Male; D008568:Memory / Q000502:physiology; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D008585:Meningitis, Meningococcal / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000473:pathology / Q000523:psychology; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000502:physiology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone