Acute EEG findings in HIV-infected Zambian adults with new-onset seizure.

Journal: Neurology

Volume: 84

Issue: 13

Year of Publication: 2015

Affiliated Institutions:  From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD. osiddiqi@bidmc.harvard.edu. From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.

Abstract summary 

To describe acute EEG findings in HIV-infected adults with new-onset seizure, assess baseline clinical characteristics associated with EEG abnormalities, and evaluate the relationship between EEG abnormalities and recurrent seizure.Eighty-one HIV-infected adults with new-onset seizure had EEG recordings during their index admission. Baseline characteristics assessed included HIV stage, seizure semiology, serum and CSF studies, neuroimaging, cognitive function based on the Zambian Mini-Mental State Examination and International HIV Dementia Scale, and psychiatric symptoms using the Shona Symptom Questionnaire. We evaluated the relationship between baseline characteristics and EEG abnormalities. Patients were followed for seizure recurrence, and the association between acute EEG abnormalities and seizure recurrence was assessed. Death was a secondary outcome.Fifty-five patients had abnormal EEGs (68%): 18 (22%) had interictal spikes (12) or a recorded seizure (6). Among baseline clinical characteristics, more advanced HIV disease (p = 0.039) and any imaging abnormality (p = 0.027) were associated with abnormal EEGs. Cortical (p = 0.008) and white matter (p = 0.004) abnormalities were associated with slow posterior dominant rhythm. Patients were followed for a median of 303 days (interquartile range 103-560). Twenty-four (30%) died and 23 (28%) had recurrent seizures. EEG abnormalities were not associated with recurrent seizure. There was a nonsignificant association between seizures recorded during EEG and death (67% vs 26%, p = 0.051).EEG abnormalities are common in this population, particularly in patients with imaging abnormalities and advanced HIV. Acute EEG abnormalities were not associated with recurrent seizure, but high mortality rates during follow-up limited this analysis.

Authors & Co-authors:  Siddiqi Omar K OK Elafros Melissa A MA Sikazwe Izukanji I Birbeck Gretchen L GL Kalungwana Lisa L Potchen Michael J MJ Bositis Christopher M CM Koralnik Igor J IJ Theodore William H WH

Study Outcome 

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Citations :  Siddiqi O, Birbeck GL. Safe treatment of seizures in the setting of HIV/AIDS. Curr Treat Options Neurol 2013;15:529–543.
Authors :  9
Identifiers
Doi : 10.1212/WNL.0000000000001411
SSN : 1526-632X
Study Population
Male,Female
Mesh Terms
AIDS Dementia Complex
Other Terms
Study Design
Study Approach
Country of Study
Mali
Publication Country
United States