Prevalence of Seizures in Children Infected With Human Immunodeficiency Virus

Abstract

A retrospective study of 354 human immunodeficiency virus (HIV)-infected patients identified a subgroup of 27 children with seizures (7.6%, 95% confidence interval: 5.1%-10.9%). Of the total group, 13% (n = 46) had identifiable neurologic deficits and 30% (n = 107) had developmental delay. Both observations were significantly more frequent in the subgroup of patients with seizures (P < .001). The median age of patients with seizures was 20 months (range, 8-87 months) and the median baseline CD4 percentage was 13.5% (interquartile range, 8%-23%). Seizures were treated with sodium valproate (n = 11), phenobarbital (n = 3), diazepam (n = 2), lamotrigine (n = 1), and carbamazepine (n = 1). Combination therapy was required for 5 children. Suboptimal valproic acid levels were recorded for 3 patients. When resources are available, antiepileptic drug level monitoring is advised for children who require both antiepileptic and antiretroviral medications to facilitate optimal seizure management.

Early Antiretroviral Therapy Is Protective Against Epilepsy in Children With Human Immunodeficiency Virus Infection in Botswana

“…CNS infections and HIV neurotoxicity were the most common causes of epilepsy in this population, similar to what has been reported in the adult literature and in the one prior pediatric study. 1-7; 23, 24 There were notable differences in epilepsy etiology between the early and late treatment groups, supporting the idea that the mechanism by which early treatment reduces epilepsy is through reduction in rates of CNS infections and HIV neurotoxicity. 25 …”

“…1-6 Seizures are common in children with HIV, with a recent South African study identifying seizures in 7.6% of their cohort. 7 However, the prevalence of seizures in adults with HIV has declined from 17% in the era prior to the introduction of combination antiretroviral therapy (cART) to 3 to 6% in more recent studies, suggesting that treatment with cART may reduce the risk of seizures. 3-5 Earlier initiation of cART may provide additional protection against factors predisposing to seizures compared to late initiation of cART.…”

Prevalence, causes, and behavioral and emotional comorbidities of acute symptomatic seizures in Africa: A critical review

“…There are no African estimates on acute symptomatic seizures caused by head injuries, which are studied in the context of epilepsy . Although acute symptomatic seizures occur in 5–11% of children with human immunodeficiency virus (HIV), seizures are often overlooked in the HIV studies assessing neurological outcomes . Hypoxic‐ischemic encephalopathy and sickle cell disease are associated with about 1% of acute symptomatic seizure cases admitted to hospitals in Kenya .…”

The assessment and management of pain in children with Guillain-Barré Syndrome in a sub-Saharan setting.

“…Carbamazepine is associated with adverse effects related to its toxic metabolite and drug-drug interactions [36]. In the sub-Saharan setting due to the high prevalence of HIV, carbamazepine is ideally avoided in combination with antiretroviral therapy to avoid AED toxicity and HIV treatment failure [37]. In this setting, Gabapentin has a more favourable pharmacokinetic profile as it has an equivalent bioavailability to carbamazepine, is excreted unchanged via the kidneys, does not induce cytochrome p450, has fewer drug interactions and an overall better side effect profile [38].…”