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Prospective Study of New-Onset Seizures in Patients With Human Immunodeficiency Virus Infection
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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