Frequency of seizures and epilepsy in neurological HIV-infected patients

SummaryBackgroundInfection with the human immunodeficiency virus (HIV) is associated both with infections of the central nervous system and with neurological deficits due to direct effects of the neurotropic virus. Seizures and epilepsy are not rare among HIV-infected patients. We investigated the frequency of acute seizures and epilepsy of patients in different stages of HIV infection. In addition, we compared the characteristics of patients who experienced provoked seizures only with those of patients who developed epilepsy.MethodsThe database of the Department of Neurology, University of Münster, was searched for patients with HIV infection admitted between 1992 and 2004. Their charts were reviewed regarding all available sociodemographic, clinical, neurophysiological, imaging and laboratory data, therapy and outcome. Stage of infection according to the CDC classification and the epileptogenic zone were determined.ResultsOf 831 HIV-infected patients treated in our department, 51 (6.1%) had seizures or epilepsy. Three of the 51 patients (6%) were diagnosed with epilepsy before the onset of the HIV infection. Fourteen patients (27%) only had single or few provoked seizures in the setting of acute cerebral disorders (eight patients), drug withdrawal or sleep withdrawal (two patients), or of unknown cause (four patients). Thirty-four patients (67%) developed epilepsy in the course of their HIV infection. Toxoplasmosis (seven patients), progressive multifocal leukencephalopathy (seven patients) and other acute or subacute cerebral infections (five patients) were the most frequent causes of seizures. EEG data of 38 patients were available. EEG showed generalized and diffuse slowing only in 9 patients, regional slowing in 14 patients and regional slowing and epileptiform discharges in 1 patient. Only 14 of the patients had normal EEG. At the last contact, the majority of the patients (46 patients=90%) were on highly active antiretroviral therapy (HAART). Twenty-seven patients (53%) were on anticonvulsant therapy (gabapentin: 14 patients, carbamazepine: 9 patients, valproate: 2 patients, phenytoin: 1 patient, lamotrigine: 1 patient). Patients with only provoked seizures had no epilepsy risk factors except HIV infection, and were less likely to be infected via intravenous drug abuse.ConclusionsSeizures are a relevant neurological symptom during the course of HIV infection. Although in some patients seizures only occur provoked by acute disease processes, the majority of patients with new onset seizures eventually develops epilepsy and require anticonvulsant therapy. Intravenous drug abuse and the presence of non-HIV-associated risk factors for epilepsy seem to be associated with the development of chronic seizures in this patient group

Progress in autoimmune epileptic encephalitis

Purpose of review Autoimmune epileptic encephalopathy is a potentially treatable neurological syndrome characterized by the coexistence of a neuronal antibody in serum and, often, cerebrospinal fluid. Patients present with combinations of seizures, neuropsychiatric features, movement disorder, and cognitive decline, but some patients have isolated seizures either at first presentation or during their illness. This review summarizes our current understanding of the roles of specific neuronal antibodies in epilepsy-related syndromes and aims to aid the clinician in diagnosis and treatment. Recent findings Antigen discovery methods in three neuroimmunology centres independently identified antibodies to different subunits of the γ amino butyric acid-A receptor; high levels of these antibodies were found mainly in patients with severe refractory seizures. These and other antibodies were also found in a proportion (<10%) of children and adults with epilepsy. A clinical study comparing immunotherapy in patients with autoantibodies or without an identified target antigen found neuroinflammatory features were predictive of a therapeutic response. New in-vitro and in-vivo studies, and spontaneous animal models, have confirmed the pathogenicity and epileptogenicity of neuronal antibodies and their relevance to other mammals. Summary Neuronal antibodies are an important cause of autoimmune epileptic encephalopathy, early recognition is important as there may be an underlying tumour, and early treatment is associated with a better outcome. In the absence of an antibody, the clinician should adopt a pragmatic approach and consider a trial of immunotherapy when other causes have been excluded

Antibody-associated epilepsies: Clinical features, evidence for immunotherapies and future research questions.

PURPOSE: The growing recognition of epilepsies and encephalopathies associated with autoantibodies against surface neuronal proteins (LGI1, NMDAR, CASPR2, GABABR, and AMPAR) means that epileptologists are increasingly asking questions about mechanisms of antibody-mediated epileptogenesis, and about the use of immunotherapies. This review summarizes clinical and paraclinical observations related to autoimmune epilepsies, examines the current evidence for the effectiveness of immunotherapy, and makes epilepsy-specific recommendations for future research. METHOD: Systematic literature search with summary and review of the identified publications. Studies describing the clinical characteristics of autoantibody-associated epilepsies and treatments are detailed in tables. RESULTS: Literature describing the clinical manifestations and treatment of autoimmune epilepsies associated with neuronal cell-surface autoantibodies (NSAbs) is largely limited to retrospective case series. We systematically summarize the features of particular interest to epileptologists dividing patients into those with acute or subacute encephalopathies associated with epilepsy, and those with chronic epilepsy without encephalopathy. Available observational studies suggest that immunotherapies are effective in some clinical circumstances but outcome data collection methods require greater standardization. CONCLUSIONS: The clinical experience captured suggests that clusters of clinical features associate well with specific NSAbs. Intensive and early immunotherapy is indicated when patients present with autoantibody-associated encephalopathies. It remains unclear how patients with chronic epilepsy and the same autoantibodies should be assessed and treated. Tables in this paper provide a comprehensive resource for systematic descriptions of both clinical features and treatments, and highlight limitations of current studies

Il ruolo del fisioterapista nella concussione cerebrale da trauma sportivo: proposta per un programma riabilitativo post traumatico.

Background: La concussione cerebrale senza perdita di coscienza è la forma più comune di trauma cranico lieve correlata all'attività sportiva e in grado di determinare un’immediata, breve, alterazione delle funzioni cerebrali. Obiettivo: Individuare un programma riabilitativo post traumatico, efficace per la risoluzione dei sintomi post-concussivi, per accelerare i tempi di recupero e per accompagnare l’atleta al ritorno all’attività sportiva in sicurezza. Metodi: Utilizzo di database elettronici: PubMed, Cochrane e PEDro. I criteri di selezione degli studi sono i seguenti: lingua inglese e italiana, dal 2009 ad oggi, solo RCT e con PEDro Scale ≥ 6. Risultati: Tra gli 81 articoli selezionati, numerosi compaiono più volte durante la ricerca, per cui risultano utili 31 studi. Di questi ne sono stati scartati: 10 perché con outcome non interessante ai fini del trattamento fisioterapico; 10 perché con risultati inconcludenti e 7 perché con punteggio PEDro Scale < 6. Quindi sono stati inclusi nella revisione: 4 studi randomizzati e controllati. Conclusioni: L’attività aerobica a bassa-media intensità ad incremento graduale è più efficace nel ridurre i sintomi post-concussivi rispetto alla sola Usual Care. La somministrazione di esercizi aerobici e un intervento riabilitativo progressivo e individualizzato, entro le prime due settimane post-traumatiche sono efficaci nell’ accelerare i tempi di recupero, rispetto ad un trattamento fisioterapico di Usual Care. Saranno necessari ulteriori studi per corroborare questi risultati, che nel caso venissero confermati, porterebbero a un decisivo cambiamento nel trattamento delle concussioni cerebrali. Parole chiave: sport-related brain concussion AND physiotherapy, sport-related brain concussion AND rehabilitation, sport-related brain concussion AND treatment, sport-related brain concussion AND physical exercise, sport-related brain concussion AND exercise therapy, sport-related brain concussion AND exercise therapy