<scp>HIV</scp> and new onset seizures: slipping through the cracks in <scp>HIV</scp> care and treatment

Sikazwe, Izukanji; Elafros, Melissa A.; Bositis, Christopher M.; Siddiqi, Omar K.; Koralnik, Igor J.; Kalungwana, Lisa; Theodore, William H.; Okulicz, Jason F.; Potchen, Michael J.; Birbeck, Gretchen L.

doi:10.1111/hiv.12283

Cited by 22 publications

(23 citation statements)

References 20 publications

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“…In contrast to this, other authors [22] reported that status epilepticus was a predictor of mortality. Unlike a study done in Zambia [18] which reported women to have a higher mortality, gender was not associated with mortality in this study.…”

Section: Discussioncontrasting

confidence: 99%

Seizure in HIV-infected Patients: Clinical Presentation, Cause and Treatment Outcome in Ethiopia: A Retrospective Study

Amare

2020

Preprint

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Background: The estimated number of adult patients living with HIV infection in Ethiopia in 2012 was approximately 800,000. Seizure occurs in 2 to 3 % and 6.1 % to 34.3% in patients with HIV infection and patients with neurological complications of HIV infection, respectively. Studies on HIV infection and seizure are rare in Ethiopia. The purpose of this study was to assess clinical presentation, cause and treatment outcome of patients with HIV infection presented with seizure. Methods: In this retrospective study, patients aged ≥ 13 years with HIV infection presented with seizure were included. Medical records were reviewed and demographic and clinical data were collected.Results: Records of 146 patients were analysed. Males were 55.5% and the mean age was 34 years. The diagnosis of HIV infection was made after current hospital admission in 69% of patients. Almost all patients (98.6 %) had stage 4 HIV infection with very low CD4 count (mean = 77/mm3). In almost all patients seizure was a recent onset at current admission; either it started after admission (42.5%) or within 3 months prior to admission (52.5%). The types of seizures were: generalized tonic-clonic seizure [GTCS] (69.2%), focal motor with secondarily generalization [FMWSG] (19.9%) and simple focal motor (11%). The common causes of seizure were: cerebral toxoplasmosis (46%), tuberculous meningitis (35.6%) and cryptococcal meningitis (13.7%). Case-fatality was 53% and predictors of mortality were: seizure started after admission, change in mentation and comatose at initial evaluation. Conclusions: Most patients had stage 4 HIV infection with very low CD4 count and a recent onset seizure which started within 3 months at initial evaluation. GTCS was the commonest seizure type and most causes of seizure were central nervous system opportunistic infections. The case-fatality was high and change in sensorium was an independent predictor of mortality. To prevent the high mortality and morbidity prevention of HIV infection, early diagnosis and treatment, improving diagnostic facilities and access to non-enzyme inducing antiepileptic drugs are recommended.

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Section: Discussioncontrasting

confidence: 99%

Seizure in HIV-infected Patients: Clinical Presentation, Cause and Treatment Outcome in Ethiopia: A Retrospective Study

Amare

2020

Preprint

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“…DISCUSSION Despite the wide availability of cART, a substantial proportion of Zambian adults with newonset seizure were unaware of their HIV status prior to their first seizure 12 and had advanced HIV disease, with only about a third of the study population on cART prior to their first seizure. The majority of participants were recruited from the inpatient setting, indicating that HIV-infected patients with new-onset seizure most often present acutely.…”

mentioning

confidence: 95%

“…Public apprehension in Zambia about the safety of lumbar puncture limits its acceptance 16 and patients with a higher level of disability were more likely to provide CSF. 12 The PCR assays do not have perfect sensitivity so a negative assay does not guarantee the absence of infection. Although the commonest OIs expected in an African population with new-onset seizures were evaluated, 21 we did not perform exhaustive tests to detect all the possible viral, parasitic, fungal, and bacterial infections that could affect this population.…”

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confidence: 99%

New-onset seizure in HIV-infected adult Zambians

et al. 2017

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Objective: To identify the etiology of new-onset seizure in HIV-infected Zambian adults and identify risk factors for seizure recurrence.Methods: A prospective cohort study enrolling HIV-infected adults with new-onset seizure within 2 weeks of index seizure obtained clinical, laboratory, and neuroimaging data to determine seizure etiology. Participants were followed to identify risk factors for seizure recurrence. Risk factors for mortality were examined as mortality rates were unexpectedly high.Results: Eighty-one patients with CSF for analysis were enrolled and followed for a median of 306 days (interquartile range 61-636). Most (91%) were at WHO stage III/IV and 66 (81%) had a preseizure Karnofsky score $50. Prolonged or multiple seizures occurred in 46 (57%), including 12 (15%) with status epilepticus. Seizure etiologies included CNS opportunistic infections (OI) in 21 (26%), hyponatremia in 23 (28%), and other infections in 8 (10%). OIs included Cryptococcus (17%), JC virus (7%) and 5% each for tuberculosis, cytomegalovirus, and varicella-zoster virus. No etiology could be identified in 16 (20%). Thirty (37%) patients died during follow-up and 20 (25%) had recurrent seizures with survival being the only identifiable risk factor. Seizures are common in the HIV-infected population, often occurring in the setting of advanced stages of immunosuppression.1 New-onset seizure has been reported in up to 11% of HIVinfected individuals, 2,3 but seizure recurrence risk and risks factors for epilepsy development in HIV-infected individuals with new-onset seizure have not been delineated. Most African regions with high HIV prevalence continue to rely largely on older, enzyme-inducing antiepileptic drugs (AEDs) for epilepsy management. Given the potential for drug interactions between enzymeinducing AEDs and combined antiretroviral therapy (cART), their co-usage is not recommended, 4,5 but other seizure treatment options are often limited or nonexistent. 6 Data on the risk of seizure recurrence in HIV-infected people with new-onset seizure are needed to help guide the decision whether or not to initiate AEDs, particularly given the risk of increased drug toxicity

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“… 48 Investigators who studied the outcomes of HIV patients with epilepsy have found patient engagement to be a significant factor. Sikazwe et al 49 reported that less than half of a cohort of 320 patients in Zambia chose to participate actively in treatment.…”

Section: Seizures In Hiv/aids Patientsmentioning

confidence: 99%

Medical management of epileptic seizures: challenges and solutions

Sarma¹,

Khandker²,

Kurczewski³

et al. 2016

NDT

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Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical–psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and “pseudoseizure” patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

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HIV and new onset seizures: slipping through the cracks in HIV care and treatment

Cited by 22 publications

References 20 publications

Seizure in HIV-infected Patients: Clinical Presentation, Cause and Treatment Outcome in Ethiopia: A Retrospective Study

Seizure in HIV-infected Patients: Clinical Presentation, Cause and Treatment Outcome in Ethiopia: A Retrospective Study

New-onset seizure in HIV-infected adult Zambians

Medical management of epileptic seizures: challenges and solutions

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