Prospective study of new-onset seizures in patients with human immunodeficiency virus infection: etiologic and clinical aspects.
OBJECTIVE
To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection.


METHODS
A prospective survey of an HIV-infected patient cohort.


METHODS
Outpatients and inpatients in a university hospital in Barcelona, Spain.


METHODS
Five hundred fifty HIV-infected patients recruited over 1 year.


METHODS
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.
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects; D002540:Cerebral Cortex / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D008875:Middle Aged; D010672:Phenytoin / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology