Moulignier A, Mikol J, Pialoux G, Fénelon G, Gray F, Thiebaut J B
Service de Neurologie, Hôpital Tenon, Paris, France.
Am J Med. 1995 Jul;99(1):64-8. doi: 10.1016/s0002-9343(99)80106-5.
To describe the clinical features of new-onset seizures in HIV-1-infected persons with progressive multifocal leukoencephalopathy (PML), and to discuss potential mechanisms.
Forty-nine consecutive HIV-1-infected patients with PML attended our institutions between January 1988 and September 1993. We retrospectively analyzed cases with seizures as the presenting symptom of PML.
Twenty percent of the HIV-1-infected patients with PML presented with new-onset seizures of various types, generalized or partial. None of them met the criteria of the AIDS dementia complex or had a concomitant opportunistic infection. Their mean CD4 cell count was < 60/mm3. Brain magnetic resonance imaging showed areas of increased signal intensity on T2-weighted images in 9 cases, and atrophy in only 1 case. Lesions most often involved subcortical white matter in parieto-occipital or frontal lobes, but 2 patients had posterior fossa lesions. Image-guided stereotactic brain biopsies in 8 cases and postmortem examination in 2 confirmed the diagnosis of PML. Typical histological lesions were observed in all cases, and positive immunolabelling of oligodendroglial nuclei was obtained in all cases with the polyclonal antibody directed against late SV40 antigens. Putative causative factors for the seizures include demyelinated lesions adjacent to the cerebral cortex acting as irritative foci, axonal conduction abnormalities, or disturbances of the neuron-glia balance.
These cases illustrate that PML should be considered as a possible cause of new-onset seizures in patients with HIV-1 infection.
描述患有进行性多灶性白质脑病（PML）的HIV-1感染者新发癫痫的临床特征，并探讨潜在机制。
1988年1月至1993年9月期间，49例连续的患有PML的HIV-1感染者到我们机构就诊。我们回顾性分析了以癫痫作为PML首发症状的病例。
20%的患有PML的HIV-1感染者出现了各种类型的新发癫痫，全身性或局灶性。他们中没有人符合艾滋病痴呆综合征的标准，也没有并发机会性感染。他们的平均CD4细胞计数<60/mm³。脑磁共振成像显示，9例患者在T2加权图像上信号强度增加区域，仅1例有萎缩。病变最常累及顶枕叶或额叶的皮质下白质，但2例患者有后颅窝病变。8例患者进行了影像引导下立体定向脑活检，2例进行了尸检，均确诊为PML。所有病例均观察到典型的组织学病变，并且所有病例用针对晚期SV40抗原的多克隆抗体均获得少突胶质细胞核的阳性免疫标记。癫痫发作的可能致病因素包括邻近大脑皮质的脱髓鞘病变作为刺激灶、轴突传导异常或神经胶质平衡紊乱。
这些病例表明，PML应被视为HIV-1感染患者新发癫痫的可能原因。
