Service de neurologie, CHU de Nancy, France, Service de neuroradiologie, CHU de Nancy, France
The recent onset of partial epileptic seizures, secondary generalized partial seizures, or tonic-clonic primary generalized seizures are often diagnostic indicators of central nervous system infections (meningitis, encephalitis, single or multiple abscesses, sub-dural empyeme). The occurrence of status epilepticus (SE) from an infection is a serious factor to be considered in therapeutic management. Brain CT-scan or MRI examinations are used to establish its parasitic, mycotic, bacterial or viral etiology. These studies also serve to confirm or modify the clinical diagnosis and the geographical origin of the infection. Nevertheless normal morphological examinations do not rule out a recent infection as a causative factor in epileptic seizures. This is especially true for meningitis in all age groups but particularly in children. Indeed, epileptic seizure onset in patients with meningitis is an indication of the presence of a cerebral abscess. In the acute phase, anti-epileptic treatments are the rule of thumb. Their indication in the follow up phase with the purpose of preventing further seizures will depend upon the nature of the infection and availability of access to anti-infectious treatments. The risk of subsequent epileptic seizures is most common in patients with encephalitis and cerebral abscesses. In cases of trauma, infections affecting the central nervous system increase the risk of post-traumatic epileptic seizures.