Long‐term outcomes after new onset seizure in children living with HIV: A cohort study
Abstract Objective To determine the long‐term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. Methods Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-04-01
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| Series: | Epilepsia Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/epi4.12921 |
| _version_ | 1797231494888947712 |
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| author | Gretchen L. Birbeck Musaku Mwenechanya Ifunanya Ume‐Ezeoke Manoj Mathews Christopher M. Bositis Lisa Kalungwana David Bearden Melissa Elafros Harris A. Gelbard William H. Theodore Igor J. Koralnik Jason F. Okulicz Brent A. Johnson Namwiya Musonda Omar K. Siddiqi Michael J. Potchen Izukanji Sikazwe |
| author_facet | Gretchen L. Birbeck Musaku Mwenechanya Ifunanya Ume‐Ezeoke Manoj Mathews Christopher M. Bositis Lisa Kalungwana David Bearden Melissa Elafros Harris A. Gelbard William H. Theodore Igor J. Koralnik Jason F. Okulicz Brent A. Johnson Namwiya Musonda Omar K. Siddiqi Michael J. Potchen Izukanji Sikazwe |
| author_sort | Gretchen L. Birbeck |
| collection | DOAJ |
| description | Abstract Objective To determine the long‐term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. Methods Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30‐day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. Results Among 73 children enrolled, 28 died (38%), 22 within 30‐days of the index seizure. Median follow‐up was 533 days (IQR 18–957) with 5% (4/73) lost to follow‐up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30‐days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86–269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. Significance Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co‐usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. Plain Language Summary This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures. |
| first_indexed | 2024-04-24T15:45:17Z |
| format | Article |
| id | doaj.art-b8165826c7684909b5c44bfcbbf98fd1 |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-04-24T15:45:17Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-b8165826c7684909b5c44bfcbbf98fd12024-04-01T15:36:57ZengWileyEpilepsia Open2470-92392024-04-019275075710.1002/epi4.12921Long‐term outcomes after new onset seizure in children living with HIV: A cohort studyGretchen L. Birbeck0Musaku Mwenechanya1Ifunanya Ume‐Ezeoke2Manoj Mathews3Christopher M. Bositis4Lisa Kalungwana5David Bearden6Melissa Elafros7Harris A. Gelbard8William H. Theodore9Igor J. Koralnik10Jason F. Okulicz11Brent A. Johnson12Namwiya Musonda13Omar K. Siddiqi14Michael J. Potchen15Izukanji Sikazwe16Department of Neurology University of Rochester Rochester New York USAUniversity Teaching Hospitals Children's Hospital Lusaka ZambiaDepartment of Neurology University of Rochester Rochester New York USAUniversity Teaching Hospitals Children's Hospital Lusaka ZambiaDepartment of Family and Community Medicine University of California San Francisco San Francisco California USADepartment of Psychology University of Zambia Lusaka ZambiaDepartment of Neurology University of Rochester Rochester New York USADepartment of Neurology University of Michigan Ann Arbor Michigan USADepartment of Neurology University of Rochester Rochester New York USAClinical Epilepsy Section US National Institute of Health Bethesda Maryland USADepartment of Neurology Northwestern University Feinberg School of Medicine Chicago Illinois USADepartment of Medicine San Antonio Military Medical Center San Antonio Texas USADepartment of Biostatistics University of Rochester Rochester New York USAUniversity Teaching Hospitals Neurology Research Office Lusaka ZambiaUniversity Teaching Hospitals Children's Hospital Lusaka ZambiaDepartment of Imaging Sciences University of Rochester Rochester New York USACentre for Infectious Disease Research in Zambia Lusaka ZambiaAbstract Objective To determine the long‐term outcomes, including mortality and recurrent seizures, among children living with HIV (CLWH) who present with new onset seizure. Methods Zambian CLWH and new onset seizure were enrolled prospectively to determine the risk of and risk factors for recurrent seizures. Demographic data, clinical profiles, index seizure etiology, and 30‐day mortality outcomes were previously reported. After discharge, children were followed quarterly to identify recurrent seizures and death. Given the high risk of early death, risk factors for recurrent seizure were evaluated using a model that adjusted for mortality. Results Among 73 children enrolled, 28 died (38%), 22 within 30‐days of the index seizure. Median follow‐up was 533 days (IQR 18–957) with 5% (4/73) lost to follow‐up. Seizure recurrence was 19% among the entire cohort. Among children surviving at least 30‐days after the index seizure, 27% had a recurrent seizure. Median time from index seizure to recurrent seizure was 161 days (IQR 86–269). Central nervous system opportunistic infection (CNS OI), as the cause for the index seizure was protective against recurrent seizures and higher functional status was a risk factor for seizure recurrence. Significance Among CLWH presenting with new onset seizure, mortality risks remain elevated beyond the acute illness period. Recurrent seizures are common and are more likely in children with higher level of functioning even after adjusting for the outcome of death. Newer antiseizure medications appropriate for co‐usage with antiretroviral therapies are needed for the care of these children. CNS OI may represent a potentially reversible provocation for the index seizure, while seizures in high functioning CLWH without a CNS OI may be the result of a prior brain injury or susceptibility to seizures unrelated to HIV and thus represent an ongoing predisposition to seizures. Plain Language Summary This study followed CLWH who experienced a new onset seizure to find out how many go on to have more seizures and identify any patient characteristics associated with having more seizures. The study found that mortality rates continue to be high beyond the acute clinical presentation with new onset seizure. Children with a CNS OI causing the new onset seizure had a lower risk of later seizures, possibly because the trigger for the seizure can be treated. In contrast, high functioning children without a CNS OI were at higher risk of future seizures.https://doi.org/10.1002/epi4.12921central nervous system opportunistic infectionepilepsyfunctional statusLansky scoreorphanseizure recurrence |
| spellingShingle | Gretchen L. Birbeck Musaku Mwenechanya Ifunanya Ume‐Ezeoke Manoj Mathews Christopher M. Bositis Lisa Kalungwana David Bearden Melissa Elafros Harris A. Gelbard William H. Theodore Igor J. Koralnik Jason F. Okulicz Brent A. Johnson Namwiya Musonda Omar K. Siddiqi Michael J. Potchen Izukanji Sikazwe Long‐term outcomes after new onset seizure in children living with HIV: A cohort study Epilepsia Open central nervous system opportunistic infection epilepsy functional status Lansky score orphan seizure recurrence |
| title | Long‐term outcomes after new onset seizure in children living with HIV: A cohort study |
| title_full | Long‐term outcomes after new onset seizure in children living with HIV: A cohort study |
| title_fullStr | Long‐term outcomes after new onset seizure in children living with HIV: A cohort study |
| title_full_unstemmed | Long‐term outcomes after new onset seizure in children living with HIV: A cohort study |
| title_short | Long‐term outcomes after new onset seizure in children living with HIV: A cohort study |
| title_sort | long term outcomes after new onset seizure in children living with hiv a cohort study |
| topic | central nervous system opportunistic infection epilepsy functional status Lansky score orphan seizure recurrence |
| url | https://doi.org/10.1002/epi4.12921 |
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