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HIV-associated PML presenting as epilepsia partialis continua

S Ferrari1, S Monaco, M Morbin

  • 1Department of Neurological and Visual Sciences, University of Verona, Italy.

Journal of the Neurological Sciences
|January 8, 1999
PubMed
Summary

Epilepsia partialis continua (EPC) can be an early sign of progressive multifocal leukoencephalopathy (PML) in patients with human immunodeficiency virus (HIV). This rare presentation occurred before other seizure types or clear diagnostic findings.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroimmunology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by the JC virus, often seen in immunocompromised individuals.
  • Human immunodeficiency virus (HIV) type 1 infection is a significant risk factor for developing PML.
  • New-onset seizures are a recognized neurological complication of PML, but specific seizure types as initial manifestations are less understood.

Observation:

  • Two patients with HIV type 1 infection presented with new-onset epilepsia partialis continua (EPC).
  • EPC was the sole seizure manifestation and persisted for several weeks.
  • Initial diagnostic workup, including radiographic and electrophysiological studies, yielded negative results.

Findings:

  • Epilepsia partialis continua (EPC) was identified as an early, presenting manifestation of progressive multifocal leukoencephalopathy (PML).

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  • The patients' clinical presentation of EPC preceded other seizure types and definitive diagnostic evidence of PML.
  • This case series highlights an unusual initial neurological symptom of PML in the context of HIV infection.

    • Implications:

    • Clinicians should consider PML in HIV-infected patients presenting with new-onset EPC, even with initially negative diagnostic tests.
    • EPC may represent a distinct early clinical phenotype of PML in the context of HIV.
    • Further research is needed to understand the mechanisms and diagnostic challenges of EPC in PML-HIV co-infection.