New onset seizures in HIV-infected patients without intracranial mass lesions or meningitis—a clinical, radiological and SPECT scan study
Introduction
New onset seizures (NOS) have been described in the HIV-infected patients. Three percent of the HIV patients in a prospective study, and between 11% and 17% in retrospective studies were found to have suffered NOS at some time during their illness [1], [2], [3], [4], [5], [6], [7]. In the majority of the patients (two-thirds) reported in these studies, the NOS were associated with an intracranial mass lesion, infection or metabolic disturbance [1], [2], [3], [4], [5], [6], [7].
In 5.9–46% of the reported patients, however, no cause for the seizures was identifiable [1], [2], [3], [4], [5], [6], [7]. This latter group of the patients are of interest because they imply that the HIV infection itself may be the cause of the seizure. The nature and mechanisms by which this occurs have, however, not been defined [1], [2], [3], [4], [5], [6], [7]. Investigation by this group of the patients with no identifiable cause for the seizures is therefore important.
We describe here the clinical, biochemical and radiological features (including SPECT scan studies) of the 15 HIV-infected patients in whom no cause for the NOS were identified.
Section snippets
Patients and methods
HIV-infected patients, older than 18 years, who presented with new onset seizures (NOS) to the Chris Hani Baragwanath Hospital (CHBH) in Soweto, South Africa during the period of July 1998 to July 1999 were studied. The CHBH is a 3300-bed public university hospital that serves a predominantly black urban population of approximately 3 million people. The patients recruited into the study were in-patients, admitted to the medical wards of the CHBH. All the patients in the study were black,
Results
Fifteen HIV-infected patients with NOS and no intracranial lesion (mass lesion or meningitis) were studied (Table 1). The patients had the following characteristics.
Discussion
The cardinal feature of our HIV-positive patients was that there was no evidence of the HIV-associated opportunistic infection or space occupying lesion. The NOS were the sole neurological manifestation in these patients. None of the patients had a clinical dementia or focal neurological deficits. There was also no atrophy on the CT/MRI scans of the brain and no white matter lesions on the MRI scan of the brain (a feature of HIV encephalopathy, seen in AIDS dementia). The only imaging
References (15)
- et al.
NOS associated with HIV infection: causation and clinical features in 100 cases
Am. J. Med.
(1989) - et al.
New-onset seizures in AIDS patients: etiology, prognosis, and treatment
Neurology
(1989) - et al.
Seizures in human immunodeficiency virus infection
Arch. Neurol.
(1990) - et al.
Metabolic abnormalities and new-onset seizures in human immunodeficiency virus-seropositive patients
Epilepsia
(1995) - et al.
New-onset generalized seizures in patients with AIDS presenting to an emergency department
Acad. Emerg. Med.
(1998) - et al.
Prospective study of new-onset seizures in patients with human immunodeficiency virus infection
Arch. Neurol.
(1999) - et al.
New onset seizures associated with human immunodeficiency virus infection
Neurology
(2000)
Cited by (17)
Increased excitability in tat-transgenic mice: Role of tat in HIV-related neurological disorders
2013, Neurobiology of DiseaseCitation Excerpt :This situation is expected to favor seizure susceptibility and seizure-related damage. In fact, seizures are often observed in HIV-1 infected patients (Dore et al., 1996) also in the absence of opportunistic infections (Bartolomei et al., 1999; Modi et al., 2002). Accordingly, Tat was reported to be epileptogenic when administered i.c.v. (Sabatier et al., 1991).
Longitudinal diffusion tensor imaging and perfusion MRI investigation in a macaque model of neuro-AIDS: A preliminary study
2011, NeuroImageCitation Excerpt :The significant correlations between the longitudinal CBF changes and CD4+ T-cell counts and CD4/CD8 ratio in caudate and parietal regions suggest that CBF is sensitive to the progression of the disease and may be a potential imaging marker. Reduced CBF in caudate, prefrontal cortex, parietal lobe, etc., has been found to be correlated with the CD4+ counts or severity of dementia in previous studies about HIV-associated brain injury (Ances et al., 2006, 2009; Chang et al., 2000; Ernst et al., 2000; Maini et al., 1990; Modi et al., 2002). Our longitudinal study in SIV monkeys is consistent with these findings.
Epileptic fits and epilepsy in the elderly: General reflections, specific issues and therapeutic implications
2007, Clinical Neurology and NeurosurgeryCitation Excerpt :Bacterial meningo-encephalitis including neuroborreliosis, cerebritis, abcess formation, tuberculous granulomas, neurolues and syphilitic brain gumma's, can lead to cortical damage giving rise to recurrent seizures after successful treatment of the infection [57–61]. Viral meningo-encephalitis in elderly patients has often a more benign, self-limiting course with the exception of herpes simplex and HIV encephalitis in which seizures may occur frequently [62–65]. Cerebral toxoplasmosis, cystercicosis, and malaria may give rise to seizures and subsequent development of epilepsy [66–68].
MRI in special conditions associated with epilepsy
2005, Magnetic Resonance in EpilepsyMRI in Special Conditions Associated with Epilepsy
2004, Magnetic Resonance in Epilepsy: Neuroimaging Techniques: Second EditionNeuroimaging in human immunodeficiency virus infection
2004, Journal of Neuroimmunology