Abnormal electroencephalographyas predictor of mortality in meningoencephalitis

https://doi.org/10.19106/JMedSci005201202004

Whisnu Nalendra Tama(1*), Sekar Satiti(2), Ahmad Asmedi(3)

(1) Department of Neurology, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Department of Neurology, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Neurology, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


Although the incidence of meningoencephalitis has decreased,howeverits mortality remainshigh. Electroencephalography (EEG) has an important role in the management of meningoencephalitis although the imaging modalities have replaced its position. Abnormality in EEG may appear earlier than in imaging so it is expected to predict mortality.The study aimed to investigate the prognostic role of EEG results in predicting mortality of meningoencephalitis.This was an observational prospective cohort study involvingmeningoencephalitis patients in Dr. Sardjito General Hospital,Yogyakartafrom July 2016 to January 2017 who underwent EEG examination.The patients who met the inclusion and exclusion criteria were divided into abnormal and normal EEG groups. The outcomewas the mortality during hospitalization. Furthermore, the type of EEG abnormalities associated with mortality were evaluated.Thirty-eight patients with the mean age was 33.61±20.37 yearwere involved in this study. Twenty-eight patients (73.7%) had abnormal EEG result and 10 patients (26.3%) death.Bivariate analysis showed that abnormal EEG result (p =0.028) and Glasgow Coma Scale (GCS) score (p =0.005) were significantly associated with mortality. Analysis for the type of EEG abnormalities found that only diffuse slowing (p =0.001) was significantly associated with mortality. Multivariate analysis showed either abnormal EEG result or GCS score were independently predictor of mortality. Abnormal EEG and GCS score were interrelated in affecting mortality.In conclusion, abnormal EEG resultin meningoencephalitis, diffuse slowing in particular, is predictor of mortality during hospitalization


Keywords


meningoencephalitis; electroencephalography; predictor; mortality; prognosis;

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References

  1. Beckham JD, Tyler KL. Neuro-intensive care of patients with acute CNS infections. Neurotherapeutics 2012; 9(1):124-38. https://doi.org/10.1007/s13311-011-0086-5
  2. Roos KL, Tyler KL. Meningitis, encephalitis, brain abscess, and empyema. In: Hauser SL, Longo DL, Fauci AS, Kasper DL, Jameson JL, Loscalzo J, eds. Harrison’s Neurology In Clinical Medicine. 3rded. Londod: McGraw-Hill Education, LLC. 2013; pp. 493-526.
  3. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011; 364(21):2016-25. https://doi.org/10.1056/NEJMoa1005384
  4. Khairani A, Asmedi A, Sukorini U. Case fatality rate meningoensefalitis di Bangsal Saraf RSUP DR Sardjito Yogyakarta [Tesis]. Yogyakarta: Fakultas Kedokteran, Universitas Gadjah Mada, 2015.
  5. Sirven JI. EEG in Focal Encephalopathies: cerebrovascular disease, neoplasms, and infections. In: Ebersole JS, Husain AM, Nordli Jr RD, eds. Current practice of clinical electroencephalography. 4th ed. Philadelphia: Wolters Kluwer Health, 2014.
  6. Misra UK, Kalita J, Roy AK, Mandal SK, Srivastava M. Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neurosurg Psychiatry 2000; 68(3):300-3. https://doi.org/10.1136/jnnp.68.3.300
  7. Sutter R, Kaplan PW, Cervenka MC, Thakur KT, Asemota AO, Venkatesan A, et al. Electroencephalography for diagnosis and prognosis of acute encephalitis. Clin Neurophysiol 2015; 126(8):1524-31. https://doi.org/10.1016/j.clinph.2014.11.006
  8. Singh TD, Fugate JE, Hocker S, Wijdicks EFM, Aksamit Jr AJ, Rabinstein AA. Predictors of outcome in HSV encephalitis. J Neurol 2016; 263(2):277-89. https://doi.org/10.1007/s00415-015-7960-8
  9. Ho Dang Trung N, Le Thi Phuong T, Wolbers M, Nguyen Van Minh H, Nguyen Thanh V, Van MP, et al. Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study. PLoS One 2012; 7(5):e37825. https://doi.org/10.1371/journal.pone.0037825
  10. Ganiem AR, Parwati I, Wisaksana R, van der Zanden A, van de Beek D, Sturm P,et al. The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study. Aids 2009; 23(17):2309-16. https://doi.org/10.1097/QAD.0b013e3283320de8
  11. Wang IJ, Lee PI, Huang LM, Chen CJ, Chen CL, Lee WT. The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study. Eur J Paediatr Neurol 2007; 11(2):63-9. https://doi.org/10.1016/j.ejpn.2006.09.010
  12. Dzupova O, Rozsypal H, Prochazka B, Benes J. Acute bacterial meningitis in adults: Predictors of outcome. Scand J Infect Dis 2009; 41(5):348-54. https://doi.org/10.1080/00365540902849391
  13. Wall EC, Cartwright K, Scarborough M, Ajdukiewicz KM, Goodson P, Mwambene J, et al. High mortality amongst adolescents and adults with bacterial meningitis in sub-saharan Africa: an analysis of 715 cases from Malawi. PLoS One 2013; 8(7):e69783. https://doi.org/10.1371/journal.pone.0069783
  14. Roos KL, Greenlee JE. Meningitis and encephalitis. Continuum 2011; 17(5):1010-23. https://doi.org/10.1212/01.CON.0000407057.02414.a9
  15. Ganiem AR. Meningitis bakterial akut. In: Sudewi AAR, Sugianto P, Ritarwan K, eds. Infeksi pada sistem saraf. Surabaya: Airlangga University Press 2011; pp. 1-11.
  16. Jones C, Scholar EM. Viral encephalitis. In: Ikezu T, Gendelman HE, eds. Neuroimmune pharmacology. New York: Springer 2008; pp. 327-41. https://doi.org/10.1007/978-0-387-72573-4_24
  17. Archibald LK, Quisling RG. Central nervous system infections. In: Layon AJ et al., ed. Textbook of neurointensive care. London: Springer-Verlag 2013.pp. 427-517. https://doi.org/10.1007/978-1-4471-5226-2_22
  18. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351(18):1849-59. https://doi.org/10.1056/NEJMoa040845
  19. Karmarkar SA, Aneja S, Khare S, Saini A, Seth A, Chauhan BK. A study of acute febrile encephalopathy with special reference to viral etiology. Indian J Pediatr 2008; 75(8):801-5. https://doi.org/10.1007/s12098-008-0150-2
  20. Waterhouse E. Generalized Encephalopathy. In: Ebersole JS, Husain AM, Nordli Jr DR, eds. Current Practice of Clinical Electroencephalography. 4th eds. Philadelphia: Wolters Kluwer Health 2014.
  21. Gandelman-Marton R, Kimiagar I, Itzhaki A, Klein C, Theitler J, Rabey JM. Electroencephalography findings in adult patients with West Nile virus-associated meningitis and meningoencephalitis. Clin Infect Dis 2003; 37(11):1573-8. https://doi.org/10.1086/379516
  22. Donnelly EM, Blum AS. Focal and gernalized slowing, coma, and brain death. In: The Clinical neurophysiology primer. New York: Humana Press 2007. pp. 127-40. http://doi.org/10.1007/978-1-59745-271-7_9
  23. Drazkowski JF. Epileptiform activity. In: Daube JR, Rubin DI, eds. Clinical neurophysiology. 3rdeds. New York: Oxford University Press 2009. pp. 137-50.



DOI: https://doi.org/10.19106/JMedSci005201202004

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