AEGiS-11IAC: Seizures in HIV-infected patients: a clinico-epidemiological study.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Seizures in HIV-infected patients: a clinico-epidemiological study.

Int Conf AIDS 1996 Jul 7-12; 11:222 (abstract no. Th.B.186)
Pascual B, Iranzo A, Marti-Fabregas J, Domingo P, Barrio JL, Fuster M, Ris J, Sambeat MA, Cadafalch J, Nolla J; Department of Internal Medicine. Hospital de la Santa Creu i Sant Pau. Barcelona, Spain. Fax: 34-3-2919269.

Aim of the study: To describe the incidence, etiology and clinical findings of new-onset seizures in patients with human immunodeficiency virus (HIV) infection.

METHODS: A prospective study of 550 HIV-infected patients from January 1995 to December 1995. In each patient a clinical history and neurologic examination was performed. Appropriate complementary explorations (laboratory and serologic studies, CT and MRI cranial scans, cerebral SPECT, EEG, CSF examination and neuropsychological evaluation) were made.

RESULTS: Seventeen out of 550 patients (3.1%) were found to have a new-onset seizure during the study period. The mean follow-up period was 6.2 plus or minus 3.6 months (range: 1-12). Three patients (17.6%) died. There were 11 men (64.7%) and 6 women (35.3%), with a mean age of 32.8 plus or minus 5.7 years (range: 22-45). At the time of the first seizure, 13 patients (76.5%) had had an AIDS-defining condition. The mean CD4 count was 115.8 plus or minus 168/mm3 (range: 3-446). Risk factors for HIV infection were intravenous drug abuse (9), homosexuality (4), and heterosexual transmission (4). The mean latency between HIV infection diagnosis and first seizure was 60.7 plus or minus 37.6 months (range: 1-120). Generalized seizures were observed in 11 patients, partial seizures in 6, but subsequent generalization was observed in all patients with partial seizures. Three patients (17.6%) presented epileptic status. Four patients (23,5%) had only one seizure. Seizures were attributed to drug toxicity in 8 patients (47.0%): foscarnet (2), ceftazidime (1), sulphamides (1), imipenem (1), cocaine (1), heroin (1) and benzodiazepine abstinence (1). Intracranial lesions were found in 6 patients (35.3%): cerebral toxoplasmosis (5) and progressive multifocal leukoencephalopathy (1), and metabolic derangements in 2: hypoglycemia (1) and hypomagnesemia (1). No etiology was found in one patient despite thorough evaluation.

CONCLUSIONS: New-onset seizures are a rare manifestation in HIV-infected patients. The seizures usually occurred in patients with severe immunodepression. The cause of the seizure was identified in most of our patients, being intracranial disorders and toxic metabolic disturbances the main etiologies. Generalized seizures were the most common type manifestation.

Keywords: AEGIS, Seizures, Acquired Immunodeficiency Syndrome, HIV Infections, Epilepsy, Leukoencephalopathy, Progressive Multifocal, Epilepsies, Partial, CD4 Lymphocyte Count, Electroencephalography, Toxoplasmosis, Cerebral, Brain, Magnetic Resonance Imaging, Tomography, Emission-Computed, Single-Photon, Prospective Studies, Human, Female, Male, radionuclide imaging, ICA11

960707
ThB186