Abstracts

Infection with the Human Immunodeficiency Virus (HIV) is associated with infections of the central nervous system secondary to immunodeficiency as well as with neurological deficits due to direct effects of the neurotropic virus itself. Seizures and epilepsy are not rare among HIV-infected patients. However, systematic data about incidence and prevalence of seizures and epilepsy in HIV-positive patients are scarce. We intended to investigate the incidence and prevalence of acute seizures and epilepsy in neurological patients infected with HIV. The database of the Department of Neurology, University Hospitals Münster, was searched for patients with HIV-infection admitted to in-patient or out-patient treatment between 1992 and 2004. Their charts were reviewed regarding all available sociodemographic, clinical, neurophysiological, imaging and laboratory data. If possible, information about seizure therapy and outcome was gathered. Stage of infection according to the CDC-classification. Of 831 HIV-infected patients admitted to our department, 51 (6,2%) had seizures and/or epilepsy. Eight of the 51 patients (16%) were diagnosed with epilepsy before the onset of the HIV-infection. Eleven patients (22%) only had single or few provoked seizures in the setting of acute cerebral disorders (8 patients), drug withdrawal or sleep withdrawal (2 patients), or of unknown cause (1 patient). Thirty-two patients (63%) developed epilepsy in the course of their HIV-infection. Of the 51 patients, 38 (75%) were already diagnosed with the acquired immunodeficiency syndrom (AIDS) at their first documented contact. Toxoplasmosis (7 patients), progressive multifocal leukodystrophy (7 patients) and other acute or subacute cerebral infections (5 patients) were the most frequent causes of seizures. EEG data of 38 patients were available. EEG showed generalized and diffuse slowing in 14 patients, regional slowing in 12 patients and epileptiform discharges in 1 patient. Only 9 of the patients had normal EEG. The majority of the patients (46 patients=90%) were on highly active antiretroviral therapy (HAART). Twenty-seven patients (53%) were on anticonvulsant therapy (gabapentin14 patients, carbamazepine 9 patients, valproat 2 patients, phenytoin 1 patient, lamotrigine 1 patient). Seizures are a relevant neurological symptom during the course of HIV-infection. Although in some patients seizures only occur in the setting of acute disease progress, the majority of patients with newly onset seizures eventually develop epilepsy and require anticonvulsant therapy.