title: Neuroimaging abnormalities and seizure recurrence in a prospective cohort study of zambians with human immunodeficiency virus and first seizure.
abstract: In HIV-positive individuals with first seizure, we describe neuroimaging findings, detail clinical and demographic risk factors for imaging abnormalities, and evaluate the relationship between imaging abnormalities and seizure recurrence to determine if imaging abnormalities predict recurrent seizures. Among 43 participants (mean 37.4 years, 56% were male), 16 (37%) were on antiretroviral drugs, 32 (79%) had advanced HIV disease, and (28) 66% had multiple seizures and/or status epilepticus at enrollment. Among those with cerebrospinal fluid studies, 14/31 (44%) had opportunistic infections (OIs). During follow-up, 9 (21%) died and 15 (35%) experienced recurrent seizures. Edema was associated with OIs (odds ratio: 8.79; confidence interval: 1.03-236) and subcortical atrophy with poorer scores on the International HIV Dementia Scale) (5.2 vs. 9.3; P=0.002). Imaging abnormalities were not associated with seizure recurrence or death (P>0.05). Seizure recurrence occurred in at least a third and over 20% died during follow-up. Imaging was not predictive of recurrent seizure or death, but imaging abnormalities may offer additional diagnostic insights in terms of OI risk and cognitive impairment.
authors.affiliation: Neuroradiology Division Department of Imaging Sciences, University of Rochester , NY, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Potchen
authors.affiliation: Department of Internal Medicine, University of Zambia , Lusaka, Zambia ; Division of NeuroVirology, Beth Israel Deaconess Medical Center , Boston, MA, USA.
authors.forename: Omar K
authors.initials: OK
authors.lastname: Siddiqi
authors.affiliation: College of Human Medicine, Michigan State University , East Lansing, MI, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Elafros
authors.affiliation: Division of NeuroVirology, Beth Israel Deaconess Medical Center , Boston, MA, USA.
authors.forename: Igor J
authors.initials: IJ
authors.lastname: Koralnik
authors.affiliation: Clinical Epilepsy Section, United States National Institutes of Health , Bethesda, MD, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Theodore
authors.affiliation: Centre for Infectious Disease Research in Zambia , Lusaka, Zambia.
authors.forename: Izukanji
authors.initials: I
authors.lastname: Sikazwe
authors.affiliation: Department of Psychology, University of Zambia , Lusaka, Zambia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kalungwana
authors.affiliation: Greater Lawrence Family Health Center , Lawrence, MA, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bositis
authors.affiliation: Epilepsy Division, Department of Neurology, University of Rochester , NY, USA ; Chikankata Epilepsy Care Team , Mazabuka, Zambia.
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
keywords: CHASE; cognitive impairment; computed tomography; opportunistic infection; prognosis; seizure recurrence