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Etiologic and Clinical Aspects

Berta Pascual-Sedano, MD; Alejandro Iranzo, MD; Joan Martí-Fàbregas, MD; Pere Domingo, MD; Antonio Escartin, RN, MD; Montserrat Fuster, MD; Josep L. Barrio, MD; Maria A. Sambeat, MD

Arch Neurol. 1999;56:609-612.

Objective  To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection.

Design  A prospective survey of an HIV-infected patient cohort.

Setting  Outpatients and inpatients in a university hospital in Barcelona, Spain.

Patients  Five hundred fifty HIV-infected patients recruited over 1 year.

Main Outcome Measure  Analysis of new-onset seizures, with detailed medical history and appropriate workup.

Results  Seventeen HIV-infected patients (3%) had a new-onset seizure during the study period. Fourteen (82%) of 17 patients had acquired immunodeficiency syndrome diagnosed according to the 1993 CDC Expanded AIDS Definition. Mean latency (±SD) between diagnosis of HIV infection and the first seizure was 60.7 ± 37.6 months. Seizure cause was drug toxicity in 8 patients (47%) and intracranial lesion in 6 patients (35.3%). Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients (70.6%), simple partial motor seizure in 2 (11.8%), and simple partial seizure evolving to generalized seizure in 3 (17.6%). We found partial seizures in 66.6% of patients who had intracranial lesions. Most patients were treated with phenytoin, which was well tolerated and effective in controlling seizures.

Conclusions  New-onset seizures are infrequent in patients with HIV. In most cases a definite or probable cause is identified, which is usually related to toxic and/or metabolic factors. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.

From the Departments of Neurology (Drs Pascual-Sedano, Iranzo, Martí-Fàbregas, and Escartín) and Internal Medicine (Drs Domingo, Fuster, Barrio, and Sambeat), Hospital de Sant Pau, Barcelona, Spain.

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