Cerebral tuberculosis and secondary epilepsy - Interactions between antiepileptic and antituberculous treatment

Abstract

Central nervous system (CNS) involvement represents almost 1% of all cases of active tuberculosis. It represents a form with a high level of morbidity and mortality in spite of appropriate treatment. There isn’t any agreement regarding the duration of the antituberculous treatment. We report a case related to cerebral tuberculomas and another case related to interactions between antiepileptic drugs and antituberculous treatment. The first case involves cerebral tuberculomas discovered on brain imaging (CT scan, cerebral MRI) and secondary epilepsy. The patient did an antituberculous treatment for pulmonary tuberculosis and tuberculous meningitis for one year, consisting of 4 drugs (HRZE). Six months later, he checked into our clinic with a tonic clonic seizure and we discovered tuberculomas on the cerebral MRI. Shortly thereafter we started the treatment with 5 drugs (HRZES) and anticonvulsants. Five months later the MRI showed multiple enhancing lesions described as “a bunch of grapes”, potentially matching multiple tuberculomas. The second case shows the interaction between anticonvulsants and antituberculous drugs in concomitant pulmonary tuberculosis and epilepsy with tonic clonic seizures. We measured the concentration of anticonvulsants in the blood during the antituberculous treatment.