title: Status epilepticus in central nervous system infections: an experience from a developing country.
abstract: OBJECTIVE
  There is a paucity of comprehensive study in status epilepticus in central nervous system infections. This observational study evaluated the response to antiepileptic drugs in patients with status epilepticus and central nervous system infection.
  
  
  METHODS
  The study took place at a tertiary care teaching hospital in India. A total of 37 of 93 adult patients (39.8%) with status epilepticus had central nervous system infection, and they underwent clinical evaluation, including status type and duration. Magnetic resonance imaging and cerebrospinal fluid analyses were performed. Patients were categorized into encephalitis, meningitis, and granuloma groups. The response to antiepileptic drugs was noted, and the status was considered refractory if seizures continued after the second antiepileptic drug. Refractory status epilepticus and mortality were correlated with the type of infection and various clinical and magnetic resonance imaging findings.
  
  
  RESULTS
  The median age of the patients was 37 years (16-78 years), and 17 patients were female; 35 patients had convulsive status epilepticus, and 2 patients had nonconvulsive status epilepticus. Twenty patients had encephalitis (Japanese 4, herpes simplex 3, nonspecific 12), including 1 patient with malaria, 9 patients with meningitis (tubercular 5, pyogenic 3, fungal 1), and 7 patients with granuloma (tubercular 5, neurocysticercosis 2). The mean duration of status epilepticus was 19.6 hours (0.25-72 hours). Magnetic resonance imaging results were abnormal in 66.7% of patients. In 67.6% of patients, status epilepticus was controlled after the first antiepileptic drug. Some 24.3% of patients were refractory to the second antiepileptic drug, and 10.8% of patients did not respond to the third antiepileptic drug. Patients with encephalitis had an insignificantly poor response. Eleven patients (29.7%) died, and mortality was higher in patients with refractory status epilepticus.
  
  
  CONCLUSIONS
  Of patients with status epilepticus and central nervous system infection, 24.3% had a refractory status that was associated with a high mortality. Their response to an antiepileptic drug in encephalitis was insignificantly poorer.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Usha Kant
authors.initials: UK
authors.lastname: Misra
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.forename: Pradeep P
authors.initials: PP
authors.lastname: Nair
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D002494:Central Nervous System Infections / Q000150:complications* / Q000401:mortality; D003906:Developing Countries; D003975:Diazepam / Q000627:therapeutic use; D004351:Drug Resistance; D004569:Electroencephalography; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007194:India / Q000453:epidemiology; D008140:Lorazepam / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D011446:Prospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid; D010672:Phenytoin; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam