Related Experiment Videos
Isolated, chronic, epilepsia partialis continua in an HIV-infected patient
F Bartolomei1, M Gavaret, C Dhiver
1Centre Saint-Paul for Epilepsy, Department of Neurophysiology and Neuropsychology, Université de la Méditerranée, Marseille, France.
Background:
The characteristic clinical feature of epilepsia partialis continua (EPC) is chronic focal myoclonus, usually involving the distal part of one extremity. A variety of pathogenetic factors have been implicated in EPC. In children, the most common cause is Rasmussen encephalitis; in adults, it is vascular disease or tumor involving the sensorimotor cortex. Epileptic seizures are a relatively common manifestation of central nervous system involvement in patients infected with human immunodeficiency virus (HIV), but, to our knowledge, isolated, chronic EPC has not been previously reported.
Objective:
To describe a case of typical EPC in a patient infected with HIV.
Design And Setting:
Case report from an epilepsy center.
Patient:
A 58-year-old man infected with HIV had continuous myoclonus that involved the right arm and was associated with intermittent motor seizures. The electroencephalographic findings were normal at the onset of the symptoms, but left central theta rhythm appeared later. Serial magnetic resonance imaging scans obtained over a 3-month period showed a progressively increasing left rolandic T2-weighted hypersignal. Histologic study of a stereotactic biopsy specimen demonstrated inflammation characterized by perivascular mononuclear cell infiltration. The only detectable cause was HIV infection. Immunocytochemical tests ruled out JC virus. Neuropsychological testing showed no evidence of cognitive impairment. An electroencephalographic-electromyographic "back-averaging" study showed a reproducible transient left biphasic complex preceding the bursts by about 30 milliseconds on the C3 and F3 electrodes, thus demonstrating that the myoclonus was of cortical origin. High-dose corticosteroid (prednisone, 100 mg/d) and anti-HIV- 1 therapy led to marked radiological and clinical improvement. Infection with HIV enhances the risk of seizures, but, to our knowledge, this is the first reported case of "inflammatory" EPC.
Conclusions:
The present case suggests that the possibility of central nervous system involvement by HIV-1 should be taken into account in the diagnostic workup of patients with EPC. This case also indicates that treatment can be effective.
Insights
This case report details a patient with human immunodeficiency virus (HIV) who developed epilepsia partialis continua (EPC), a rare form of continuous focal seizures. Early diagnosis and treatment with corticosteroids and antiretroviral therapy led to significant improvement.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Epilepsia partialis continua (EPC) is characterized by chronic focal myoclonus, often affecting extremities.
- While various factors cause EPC, Rasmussen encephalitis is common in children, and vascular disease or tumors in adults.
- Human immunodeficiency virus (HIV) infection is known to cause seizures, but isolated EPC has not been previously reported.
Observation:
- A 58-year-old man with HIV presented with continuous right arm myoclonus and intermittent motor seizures.
- Electroencephalography showed normal findings initially, later revealing left central theta rhythm. Magnetic resonance imaging indicated a progressive left rolandic T2-weighted hypersignal.
- Histopathology of a biopsy specimen revealed inflammation with mononuclear cell infiltration, with HIV infection identified as the sole cause.
Findings:
- The myoclonus was confirmed to be of cortical origin through electroencephalographic-electromyographic back-averaging.
- Treatment with high-dose corticosteroids and anti-HIV-1 therapy resulted in marked radiological and clinical improvement.
- This is the first reported case of "inflammatory" EPC associated with HIV infection.
Implications:
- Central nervous system involvement by HIV-1 should be considered in the differential diagnosis of EPC.
- This case highlights that EPC in HIV-positive individuals can be effectively treated.
- The findings underscore the importance of considering opportunistic infections in the neurological manifestations of HIV.