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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Optimizing therapy of seizures in patients with HIV and cysticercosis

From the Department of Neurology, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa (Dr. Bhigjee) and Santa Casa School of Medicine, Department of Pediatrics, Child Neurology Division, Sao Paulo, Brazil (Dr. Rosemberg).

Address correspondence and reprint requests to Dr. A. I. Bhigjee, Department of Neurology, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville 4058, South Africa;e-mail: Bhigjee{at}ukzn.ac.za

Worldwide, about 40 million people are living with HIV and 50 million people have neurocysticercosis (NCC). About 5% of patients with HIV and the majority of patients with NCC develop recurrent seizures. Mechanisms of seizure production in HIV include mass lesions, meningitis, encephalitis, and ischemia. Seizures in NCC may occur at all stages of cyst development, from the vesicular and colloidal to the calcified stages. Seizures in HIV present special problems with regard to choice of antiepileptic drug (AED) and the potential for drug–drug interactions with antiretroviral (ARV) treatments. Newer AEDs with simpler pharmacokinetic profiles may be the preferred agents, particularly when protease inhibitors form part of ARV regimens. Seizures in NCC are easily controlled with the older AEDs. Although there has been some debate about the value of antiparasitic drugs in NCC, accumulating data suggest that the use of these agents in active disease decreases the risk for development of chronic epilepsy.

This supplement has been supported through an unrestricted grant from UCB S.A., manufacturers of levetiracetam (Keppra®).

Disclosure: Dr. Bhigjee has received speaker fees from the sponsor of this supplement. Dr. Rosemberg reports no conflicts of interest.

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represents the opinions of the authors and is not endorsed by nor does it reflect the views of the American Academy of Neurology, Editorial Board, Editor-in-Chief, or Associate Editors of Neurology.