Siddiqi Omar K, Elafros Melissa A, Bositis Christopher M, Koralnik Igor J, Theodore William H, Okulicz Jason F, Kalungwana Lisa, Potchen Michael J, Sikazwe Izukanji, Birbeck Gretchen L
From the Global Neurology Program, Department of Neurology (O.K.S., I.J.K.), and Center for Virology and Vaccines Research, Department of Internal Medicine (O.K.S., I.J.K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine (UNZA-SOM), Lusaka; College of Human Medicine (M.A.E.), Michigan State University (MSU), East Lansing; Greater Lawrence Family Health Center (C.M.B.); Clinical Epilepsy Division (W.H.T.), United States National Institutes of Health, Bethesda, MD; HIV Evaluation Unit (J.F.O.), Infectious Disease Service, San Antonio Military Medical Center, TX; Department of Psychiatry (L.K.), University of Zambia (UNZA), Lusaka; Neuroradiology Division, Department of Imaging Sciences (M.J.P.), and Strong Epilepsy Center, Department of Neurology (G.L.B.), University of Rochester, NY; Department of Radiology (M.J.P.), Lusaka Apex Medical University; Centre for Infectious Disease Research in Zambia (CIDRZ) (I.S.), Lusaka; and Epilepsy Care Team (G.L.B.), Chikankata Hospital, Mazabuka, Zambia.
Neurology. 2017 Jan 31;88(5):477-482. doi: 10.1212/WNL.0000000000003538. Epub 2016 Dec 21.
To identify the etiology of new-onset seizure in HIV-infected Zambian adults and identify risk factors for seizure recurrence.
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.
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 pre-seizure 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.
HIV-infected adults with new-onset seizure in Zambia often have advanced HIV disease with OI being the most frequent seizure etiology. Seizure recurrence is common but no risk factors for recurrence other than survival were identified. These findings suggest an urgent need for immune reconstitution in this population. Initiating treatment for seizure prophylaxis where only enzyme-inducing antiepileptic medications are available could threaten antiretroviral efficacy.
确定赞比亚感染艾滋病毒的成年新发癫痫患者的病因，并确定癫痫复发的危险因素。
一项前瞻性队列研究纳入了在首次癫痫发作后2周内出现新发癫痫的感染艾滋病毒的成年人，获取临床、实验室和神经影像学数据以确定癫痫病因。对参与者进行随访以确定癫痫复发的危险因素。由于死亡率意外高，对死亡危险因素进行了检查。
81例有脑脊液可供分析的患者入组，中位随访时间为306天（四分位间距61 - 636天）。大多数（91%）处于世界卫生组织III/IV期，66例（81%）癫痫发作前卡诺夫斯基评分≥50。46例（57%）发生了长时间或多次癫痫发作，其中12例（15%）为癫痫持续状态。癫痫病因包括中枢神经系统机会性感染（OI）21例（26%）、低钠血症23例（28%）和其他感染8例（10%）。机会性感染包括隐球菌（17%）、JC病毒（7%），结核病、巨细胞病毒和水痘 - 带状疱疹病毒各占5%。16例（20%）无法确定病因。30例（37%）患者在随访期间死亡，20例（25%）出现癫痫复发，生存是唯一可识别的危险因素。
赞比亚感染艾滋病毒的成年新发癫痫患者通常患有晚期艾滋病毒疾病，机会性感染是最常见的癫痫病因。癫痫复发很常见，但除了生存外未发现其他复发危险因素。这些发现表明该人群迫切需要免疫重建。在仅可获得酶诱导抗癫痫药物的情况下启动癫痫预防治疗可能会威胁抗逆转录病毒疗效。
