Acute EEG findings in HIV-infected Zambian adults with new-onset seizure.
OBJECTIVE
To describe acute EEG findings in HIV-infected adults with new-onset seizure, assess baseline clinical characteristics associated with EEG abnormalities, and evaluate the relationship between EEG abnormalities and recurrent seizure.


METHODS
Eighty-one HIV-infected adults with new-onset seizure had EEG recordings during their index admission. Baseline characteristics assessed included HIV stage, seizure semiology, serum and CSF studies, neuroimaging, cognitive function based on the Zambian Mini-Mental State Examination and International HIV Dementia Scale, and psychiatric symptoms using the Shona Symptom Questionnaire. We evaluated the relationship between baseline characteristics and EEG abnormalities. Patients were followed for seizure recurrence, and the association between acute EEG abnormalities and seizure recurrence was assessed. Death was a secondary outcome.


RESULTS
Fifty-five patients had abnormal EEGs (68%): 18 (22%) had interictal spikes (12) or a recorded seizure (6). Among baseline clinical characteristics, more advanced HIV disease (p = 0.039) and any imaging abnormality (p = 0.027) were associated with abnormal EEGs. Cortical (p = 0.008) and white matter (p = 0.004) abnormalities were associated with slow posterior dominant rhythm. Patients were followed for a median of 303 days (interquartile range 103-560). Twenty-four (30%) died and 23 (28%) had recurrent seizures. EEG abnormalities were not associated with recurrent seizure. There was a nonsignificant association between seizures recorded during EEG and death (67% vs 26%, p = 0.051).


CONCLUSIONS
EEG abnormalities are common in this population, particularly in patients with imaging abnormalities and advanced HIV. Acute EEG abnormalities were not associated with recurrent seizure, but high mortality rates during follow-up limited this analysis.
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD. osiddiqi@bidmc.harvard.edu.
Omar K
OK
Siddiqi
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Melissa A
MA
Elafros
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Izukanji
I
Sikazwe
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Gretchen L
GL
Birbeck
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Lisa
L
Kalungwana
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Michael J
MJ
Potchen
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Christopher M
CM
Bositis
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
Igor J
IJ
Koralnik
From the Global Neurology Program (O.K.S., I.J.K.), Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Internal Medicine (O.K.S.), University of Zambia School of Medicine, Lusaka; International Neurologic and Psychiatric Epidemiology Program (M.A.E.) and College of Human Medicine (M.A.E.), Michigan State University, East Lansing; Epilepsy Division, Department of Neurology (G.L.B.), and Neuroradiology Division, Department of Imaging Sciences (M.J.P.), University of Rochester, NY; Chikankata Epilepsy Care Team (G.L.B.), Mazabuka; Centre for Infectious Disease Research in Zambia (I.S.), Lusaka; Department of Psychiatry (L.K.), University of Zambia, Lusaka; Greater Lawrence Family Health Center (C.M.B.), MA; and Clinical Epilepsy Section (W.H.T.), NINDS, NIH, Bethesda, MD.
William H
WH
Theodore
D015526:AIDS Dementia Complex / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D058256:Brain Waves; D003071:Cognition / Q000502:physiology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D009483:Neuropsychological Tests; D012008:Recurrence; D012640:Seizures / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D066127:White Matter / Q000473:pathology; D055815:Young Adult; D015024:Zambia