Status epilepticus - mortality rates in patients with HIV

The first report of outcomes in patients with HIV infection and status epilepticus (SE) has shown that around a third of patients died and a third developed new neurological deficits as a result of the event.The authors reviewed the medical records of 42 patients with HIV and found that the mortality rate in these patients was around twice the rate in unselected patients with SE from the same hospital. This is perhaps the result of HIV-related neurologic injury, the authors say. The findings with respect to morbidity suggest that patients who survive SE will most likely require discharge plans that take into account new neurological deficits, the authors add.The probable cause of SE in around a third of patients was CNS infection, and 40% of infection-related cases were linked to Toxoplasma. CNS tumours and antiepileptic drug withdrawal were other common potential causes, but the etiology was unknown in seven patients.Most patients (88%) responded to IV benzodiazepine or phenytoin and the remaining patients responded to phenobarbital with or without midazolam or pentobarbital infusions. Despite the effective treatment, 15 patients (36%) showed a decline in neurologic function after the episode and 12 patients (29%) died during the acute hospitalisation. The authors report no clear difference in etiology for patients who died compared with those who survived, but there was a trend toward lower CD4 counts in patients who died.Almost half of the patients had experienced a previous seizure, and the authors suggest that supoptimal antiepileptic treatment may have contributed to SE. "Although AEDs do not provide absolute protection against SE as evidenced by two patients who had recurrent seizures and SE despite adequate drug levels, most patients with previous seizures were either untreated or noncompliant with their treatments," they say. More aggressive management and patient counselling would decrease the incidence of SE in patients with HIV, the authors conclude.Reference...