PMID- 38366961 OWN - NLM STAT- MEDLINE DCOM- 20240403 LR - 20240404 IS - 2470-9239 (Electronic) IS - 2470-9239 (Linking) VI - 9 IP - 2 DP - 2024 Apr TI - Long-term outcomes after new onset seizure in children living with HIV: A cohort study. PG - 750-757 LID - 10.1002/epi4.12921 [doi] AB - 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. CI - (c) 2024 The Authors. Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. FAU - Birbeck, Gretchen L AU - Birbeck GL AUID- ORCID: 0000-0002-0735-3461 AD - Department of Neurology, University of Rochester, Rochester, New York, USA. AD - University Teaching Hospitals Children's Hospital, Lusaka, Zambia. AD - Chikankata Epilepsy Care Team, Mazabuka, Zambia. FAU - Mwenechanya, Musaku AU - Mwenechanya M AD - University Teaching Hospitals Children's Hospital, Lusaka, Zambia. FAU - Ume-Ezeoke, Ifunanya AU - Ume-Ezeoke I AD - Department of Neurology, University of Rochester, Rochester, New York, USA. FAU - Mathews, Manoj AU - Mathews M AD - University Teaching Hospitals Children's Hospital, Lusaka, Zambia. FAU - Bositis, Christopher M AU - Bositis CM AD - Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA. FAU - Kalungwana, Lisa AU - Kalungwana L AD - Department of Psychology, University of Zambia, Lusaka, Zambia. FAU - Bearden, David AU - Bearden D AD - Department of Neurology, University of Rochester, Rochester, New York, USA. AD - University Teaching Hospitals Children's Hospital, Lusaka, Zambia. FAU - Elafros, Melissa AU - Elafros M AD - Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA. FAU - Gelbard, Harris A AU - Gelbard HA AD - Department of Neurology, University of Rochester, Rochester, New York, USA. FAU - Theodore, William H AU - Theodore WH AUID- ORCID: 0000-0002-4669-5747 AD - Clinical Epilepsy Section, US National Institute of Health, Bethesda, Maryland, USA. FAU - Koralnik, Igor J AU - Koralnik IJ AD - Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. FAU - Okulicz, Jason F AU - Okulicz JF AD - Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA. FAU - Johnson, Brent A AU - Johnson BA AD - Department of Biostatistics, University of Rochester, Rochester, New York, USA. FAU - Musonda, Namwiya AU - Musonda N AD - University Teaching Hospitals Neurology Research Office, Lusaka, Zambia. FAU - Siddiqi, Omar K AU - Siddiqi OK AD - University Teaching Hospitals Children's Hospital, Lusaka, Zambia. AD - Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. FAU - Potchen, Michael J AU - Potchen MJ AD - Department of Imaging Sciences, University of Rochester, Rochester, New York, USA. AD - Zambian College of Medicine and Surgery, Lusaka, Zambia. FAU - Sikazwe, Izukanji AU - Sikazwe I AD - Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. LA - eng GR - R01NS094037/NS/NINDS NIH HHS/United States GR - R35NS122265/NS/NINDS NIH HHS/United States GR - K23 NS117310/NS/NINDS NIH HHS/United States GR - K23NS117310/NS/NINDS NIH HHS/United States GR - R35 NS122265/NS/NINDS NIH HHS/United States GR - R01 NS094037/NS/NINDS NIH HHS/United States PT - Journal Article DEP - 20240217 PL - United States TA - Epilepsia Open JT - Epilepsia open JID - 101692036 RN - 0 (Anticonvulsants) SB - IM MH - Child MH - Humans MH - Anticonvulsants/therapeutic use MH - Cohort Studies MH - Seizures/drug therapy MH - *Epilepsy, Generalized/drug therapy MH - *HIV Infections/complications/drug therapy MH - Brain Damage, Chronic/chemically induced/complications/drug therapy PMC - PMC10984287 OTO - NOTNLM OT - Lansky score OT - central nervous system opportunistic infection OT - epilepsy OT - functional status OT - orphan OT - seizure recurrence COIS- David Bearden served as a paid advisor for Biogen. The remaining authors have no conflict of interest. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. EDAT- 2024/02/17 21:43 MHDA- 2024/04/03 06:45 PMCR- 2024/02/17 CRDT- 2024/02/17 07:57 PHST- 2024/01/17 00:00 [revised] PHST- 2023/12/15 00:00 [received] PHST- 2024/02/04 00:00 [accepted] PHST- 2024/04/03 06:45 [medline] PHST- 2024/02/17 21:43 [pubmed] PHST- 2024/02/17 07:57 [entrez] PHST- 2024/02/17 00:00 [pmc-release] AID - EPI412921 [pii] AID - 10.1002/epi4.12921 [doi] PST - ppublish SO - Epilepsia Open. 2024 Apr;9(2):750-757. doi: 10.1002/epi4.12921. Epub 2024 Feb 17.