CNS infections

In CNS infections (such as meningitis or encephalitis) that present with acute symptomatic seizures (convulsions during the illness), the approach to anticonvulsant continuation depends on the risk of recurrence:

• If seizures were only acute (limited to the acute phase of illness, with no underlying structural brain lesion, normal EEG, and full neurological recovery):
  ➝ Long-term anticonvulsant therapy is not usually needed. Anticonvulsants can often be tapered and stopped before or shortly after discharge.
• If there are risk factors for epilepsy (e.g., abnormal EEG, persistent neurological deficits, underlying brain insult such as encephalitis):
  ➝ Short- to medium-term anticonvulsant therapy may be continued, often for 3–6 months, followed by reassessment.
• If chronic epilepsy develops (unprovoked seizures after the acute infection period), then long-term therapy is warranted.