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A Journal on Internal Medicine

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Panminerva Medica 2000 December;42(4):267-72

language: English

Neurophysiologic exploration: a reliable tool in HIV-1 encephalopathy diagnosis in children

Vigliano P., Boffi P., Bonassi E., Gandione M., Marotta C., Rainò E., Russo R. *, Rigardetto R.

From the Section of Child Neuropsychiatry
*Department of Hygiene and Community Medicine University of Turin, Italy


Background. HIV-1 ­related enceph­a­lop­athy has a bad prog­nostic ­meaning in the ­course of ­AIDS dis­ease, but the ­early asso­ci­a­tion of dif­ferent ­drugs can ­modify its ­course. For ­this ­reason it is ­very impor­tant to rec­og­nize CNS involve­ment as ­soon as pos­sible. As ­shown in the lit­er­a­ture, at ­least in ­adult ­studies, EEG and Evoked Potentials (EP) are ­good ­tools in eval­u­ating CNS alter­a­tions. In chil­dren ­data are ­rare.
Methods. A ten-­year pros­pec­tive ­study of 44 ­infected chil­dren out of 142 ­born ­from HIV-1 pos­i­tive ­mothers has ­been ­done. The chil­dren ­have ­been sub­mitted to EEG ­recording ­every six ­months in the ­first 18 ­months of ­life and ­then ­every ­year, to mul­ti­modal EP ­every six ­months. A ­total of 357 EEG, 47 P-VEP, 62 F-VEP and 98 ­BAEP ­have ­been per­formed.
Results. EEG: we ­found no path­o­logic ­results in ­patients ­belonging to cat­e­gory A; ­results ­were path­o­logic in 17.7% in cat­e­gory B, in 47.7% in C and in 77% of ence­phal­o­pathic ­patients. It ­seems ­that EEG alter­a­tions are par­allel to dis­ease pro­gres­sion, ­with a rel­a­tive ­risk of devel­oping enceph­a­lopathy (R.R.=1.15) and of ­death (R.R.=2.33) for ­patients ­belonging to cat­e­gory C. We ­obtained a sta­tis­ti­cally sig­nif­i­cant length­ening in ­BAEP inter­peak ­latency of ­left ear in all ­groups. For ­patients in cat­e­gory C the ­risk of devel­oping enceph­a­lop­athy is sta­tis­ti­cally sig­nif­i­cant (p=0.045; R.R.=6.75) and ­risk of ­death is ­high (R.R.=4).
Conclusions. Neurophysiologic ­exams are a reli­able ­tool for the diag­nosis of enceph­a­lop­athy, in addi­tion to clin­ical evi­dence.

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