1. ^*Department of Neurology, University Hospital Charité, Humboldt University, Berlin, Germany
2. ^†Department of Microbiology and Hygiene, University Hospital Charité, Humboldt University, Berlin, Germany

Correspondence: Joerg R Weber, Department of Neurology, Universitaetsklinikum Charité, Humboldt University, Schumannstrasse 20/21, 10098 Berlin, Germany; e-mail: joerg.weber@charite.de

Received 4 March 2002; Revised 26 April 2002; Accepted 26 April 2002.

Abstract

Severe headache and meningism provide clear evidence for the activation of trigeminal neurotransmission in meningitis. The authors assessed the antiinflammatory potential of 5HT_1B/D/F receptor agonists (triptans), which inhibit the release of proinflammatory neuropeptides from perivascular nerve fibers. In a 6-hour rat model of pneumococcal meningitis, zolmitriptan and naratriptan reduced the influx of leukocytes into the cerebrospinal fluid, and attenuated the increase of regional cerebral blood flow. Elevated intracranial pressure as well as the brain water content at 6 hours was reduced by triptans. These effects were partially reversed by a specific 5HT_1D as well as by a specific 5HT_1B receptor antagonist. Meningitis caused a depletion of calcitonin gene-related peptide (CGRP) and substance P from meningeal nerve fibers, which was prevented by zolmitriptan and naratriptan. In line with these findings, patients with bacterial meningitis had significantly elevated CGRP levels in the cerebrospinal fluid. In a mouse model of pneumococcal meningitis, survival and clinical score at 24 hours were significantly improved by triptan treatment. The findings suggest that, besides mediating meningeal nociception, meningeal nerve fibers contribute to the inflammatory cascade in the early phase of bacterial meningitis. Adjunctive treatment with triptans may open a new therapeutic approach in the acute phase of bacterial meningitis.