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Epilepsy - Indian context

HIV and seizures

Seizures are not uncommon in patients with human immunodeficiency virus (HIV) infection, and the upsurge in HIV infection may be an important cause for acute symptomatic seizures. Neurological disorders are the presenting manifestation in 5-10% of patients with acquired immune deficiency syndrome (AIDS) and CNS involvement is noted in 90% cases at autopsy.[ New-onset seizures were noted in 20% of HIV-seropositive individuals with neurological manifestations at our center. Cryptococcal meningitis was diagnosed in 33% cases; of these, 25% manifested with seizures.

Toxoplasmosis with granuloma or acute encephalitis appears to be the commonest cause for recent-onset seizures associated with HIV infection. Focal neurological deficits occurred in 69% and seizure in 29% of toxoplasmosis of CNS. Earlier series reported seizures in 44% of 99 patients with HIV-associated CNS tuberculosis. Of 26 patients with HIV-associated progressive multifocal leukoencephalopathy (PML), 19% manifested with seizures. Only two cases of primary CNS lymphoma were seen among our cohort of 1005 HIV-infected individuals with neurological manifestations. Seizures occur frequently in advanced HIV disease, with opportunistic infections being the main cause. Chadha et al. identified causes like cerebral toxoplasmosis in 7 (30.43%), cryptococcal meningitis in 4 (17.39%), tuberculoma in 3 (13.04%), AIDS dementia complex in 1 (4.34%), and PML in 1 (4.34%) patient.

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