The majority of CNS complications of mycoplasmal infection result from Mycoplasma pneumoniae. Neurologic complications of M. pneumoniae can begin days to weeks after the onset of respiratory symptoms. They vary in type and severity.82 Seizures can complicate mycoplasmal meningitis and meningoencephalitis.

M. pneumoniae CNS infection should be considered in the differential diagnosis of seizure and encephalopathy of unclear etiology. Caceres and colleagues83 reported a case of a 10-year-old patient presenting with seizures of focal onset and rapid secondary generalization, which did not respond to high doses of multiple anticonvulsants and ultimately required a phenobarbital drip. Continuous EEG monitoring demonstrated persistent epileptiform discharges. CSF analysis and brain biopsy studies were unrevealing, but mycoplasma pneumonia titers showed elevated immunoglobulin G (IgG) and immunoglobulin M. High-dose methylprednisolone resulted in marked EEG improvement and rapid clinical recovery.

Diagnosis

The results of CSF analysis in mycoplasmal meningitis reveal:

• Protein: normal or slightly elevated
• Glucose: normal or slightly decreased
• WBC counts: average of 80, with polymorphonuclear leukocytes averaging 25%
• Culture: isolation of the organism is difficult

Treatment

Antimicrobial treatment for CNS mycoplasmal infection is not well developed beyond the standard treatment used for non-CNS mycoplasmal infection:82

Adults:

• Erythromycin 0.5 g p.o. q6h x 14 days
• Tetracycline 0.25–0.50 g p.o. q6h x 14 days
• Clarithromycin 0.25 g p.o. q12h x 7–14 days
• Azithromycin 0.5 g p.o. x 1 day, then 0.25 g p.o. q.d. x 5 days

Children:

• < 9 yrs old: Erythromycin 30–50 mg/kg p.o. q6h x 14 days
• > 9 yrs old: Erythromycin 30 mg/kg p.o. q6h x 14 days, or
• Tetracycline 30–50 mg/kg p.o. q6h x 14 days
  > 25 kg: same as adult

Anticonvulsant management is routine.

Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised March 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.