Reaction time in patients with HIV/AIDS and correlation with CD4 count: a case-control study

There are conflicting reports on the presence of neurocognitive dysfunction during the initial, medically asymptomatic stage of HIV infection. This study aimed to assess the psychomotor speed and attention ability of antiretroviral treatment-naïve Nigerian Africans with HIV/AIDS and the impact of CD4 levels on their cognitive performance. Two hundred and eighty-eight randomly selected age-, sex- and level of education-matched subjects participated, comprising 96 HIV-positive asymptomatic and 96 HIV-positive symptomatic patients and 96 HIV-negative controls. The simple reaction and binary choice reaction time tasks were used for cognitive assessment. The binary choice reaction time indicated that the HIV-positive patients had impaired attention ability and significant psychomotor slowing compared with the controls (P<0.05), but psychomotor slowing was obvious among the symptomatic HIV-positive patients only using the simple reaction time tasks. Significant psychomotor retardation was observed in HIV-positive patients with CD4 levels of 200-499 cells/mm(3) (P=0.02) and <200 cells/mm(3) (P<0.001), and impaired ability for sustained attention was present irrespective of the CD4 level (P<0.001). We conclude that psychomotor retardation and impaired attention are significantly worse in HIV-positive subjects compared with controls and are adversely affected by decreasing CD4 levels. The sensitivity of the neuropsychological tool used can affect the degree of impairment measured.

Cognitive assessment in patients with epilepsy using the Community Screening Interview for Dementia

OBJECTIVE

Epilepsy is the most common neurological disease worldwide. It may be complicated by cognitive impairments with consequent deleterious effects on education, vocation, and social and family life of affected individuals. We assessed the cognitive functions of Nigerian patients with epilepsy using the modified Community Screening Interview for Dementia (CSID) questionnaire.

METHODS

Eighty-two subjects (41 patients with epilepsy and 41 normal controls) participated in the study. The CSID was used to assess language, memory, orientation, attention, calculation, and praxis. The SPSS statistical package was used for data analysis.

RESULTS

The mean ages (in years) of patients with epilepsy and controls were 28.32+/-9.22 and 25.98+/-7.72, respectively. The patients with epilepsy performed poorly when compared with the controls (P<0.05) in the domains Language, Memory, Attention and Calculation, and Praxis, whereas there was no statistically significant difference between the patients and controls in Orientation scores. Duration of epilepsy and of antiepileptic drug (AED) therapy had a significant negative impact on all domains of the CSID (P<0.05), whereas type of AED used did not. The CSID had a sensitivity of 91.7%.

CONCLUSION

This study showed that patients with epilepsy have significant cognitive impairments compared with controls, and duration of epilepsy and AED therapy have deleterious effects on their cognitive performance. In addition, the CSID has acceptable sensitivity and predictive value. It is recommended that cognitive function assessment should be an integral part of routine evaluation of patients with epilepsy.

Intellectual impairment in patients with epilepsy in Ile-Ife, Nigeria

INTRODUCTION

Epilepsy is the most common non-infectious neurologic disease in developing countries such as Africa, including Nigeria. This study was designed to assess the intellectual performance of patients with epilepsy (PWE) in Nigeria hoping that the result will serve as the basis for educational, vocational, and social counseling.

METHODS

Forty-one PWE were studied along with 41 age-, sex- and education-matched healthy controls. A questionnaire was developed and applied to all subjects and history was taken from patients and eyewitness. The intellectual function of each subject was assessed with the aid of Wechsler Adult Intelligence Scale adapted for Nigerians. All patients subsequently had electroencephalography (EEG) performed and the EEG findings were noted. SPSS statistical package was used to analyze the data.

RESULT

The PWE performed poorly on the verbal IQ, performance IQ, and full scale IQ scores when compared with controls (P < 0.05) and 20% of PWE had mental retardation. Long duration of epilepsy, long duration of antiepileptic drug therapy, younger age at onset of epilepsy, increased frequency of seizures, and low educational status were found to have negative impacts on intellectual performance in PWE (P < 0.05) while seizure types and type of antiepileptic drugs (carbamazepine or phenytoin) did not influence intellectual performance.

CONCLUSION

This study shows that PWE had significant intellectual impairment when compared with controls. In addition, long duration of epilepsy, long duration of AED therapy, earlier age of onset, increased seizure frequency, and low educational status had a negative impact on intellectual functioning in PWE.

Patients' knowledge about their disorder: perspective of patients with epilepsy in a tertiary health facility in southwestern Nigeria

OBJECTIVE

Previous studies have shown that patients with epilepsy do not have adequate knowledge about their disorder, suggesting that patient education is a vital part of comprehensive care for epilepsy. The goal of this study was to evaluate what Nigerian patients with epilepsy know about their disorder.

METHODS

Forty-six patients with EEG- and clinically confirmed epilepsy participated in the study. The patients completed the Epilepsy Patients Knowledge Questionnaire. The questionnaire includes topics related to etiology of epilepsy, safety, compliance, legal issues of driving, and employment. The questionnaire scores were correlated with demographic variables, duration of epilepsy, and level of education of the patients.

RESULTS

The mean age of the respondents was 26.78 ± 9.27 years; there were 27 males and 19 females. The mean duration of epilepsy in the group was 7.6 ± 7.5 years. The mean rates of correct responses to the issues of safety and compliance were 31.6 and 76.8%, respectively. The mean scores on legal issues of driving and employment were 45.7 and 42.4%, respectively. The lowest score (10.9%) was on the etiology of epilepsy.

CONCLUSION

Nigerian patients with epilepsy lack adequate knowledge about their disorder, and there is a need for improved educational intervention in these patients.

Cerebellar toxoplasmosis in HIV/AIDS: a case report

BACKGROUND

Toxoplasma encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage of human immunodeficiency viral (HIV) infection. The definitive diagnosis requires demonstration of toxoplasma in brain tissue. However, neuroradiologic demonstration (using Computed Tomography or Magnetic Resonance Imaging) of ring-enhanced multiple or single focal intracranial lesions in the presence of immunosuppression and prompt response to presumptive therapy are diagnostic in the absence of histological facilities. The rarity of toxoplasma lesions in the cerebellum prompts a high index of clinical suspicion and early institution of presumptive therapy in poor resource sub-Saharan countries like Nigeria.

OBJECTIVE

To illustrate the presentation of recurrent cerebellar toxoplasmosis in a patient with HIV/AIDS.

METHODS

A 34-year-old previously diagnosed HIV/AIDS male patient with right-sided cerebellar signs on neurological evaluation and a ring-enhancing lesion in the right cerebellar hemisphere on CT brain scan. An initial response to antitoxoplasmic drugs was short-lived due to poor compliance resulting in recurrence of lesion.

RESULTS

On initial evaluation a diagnosis of cerebellar space occupying lesion in a patient with HIV/AIDS was made. He responded to treatment with clindamycin, pyremethamine and pyridoxine. Following default in treatment for three months he represented with florid cerebellar features, but again responded rapidly to treatment.

CONCLUSION

Cerebellar toxoplasmosis is an infrequent complication of HIV/AIDS. Early diagnosis with neuro-imaging techniques and prompt institution of appropriate therapy results in remarkable improvement.

Role of lamivudine in the therapy of Nigerian patients with Chronic HBV infection

AIMS AND OBJECTIVES

The study was conducted to determine the role of lamivudine in the treatment of Nigerian patients with chronic HBV infection (CHB).

MATERIALS AND METHODS

Twenty one Nigerian patients with laboratory, histologic and clinical features of CHB were studied over a period of 30 months for response to a six-month therapy with lamivudine using liver biopsy as gold standard for assessment of response to therapy.

RESULTS

The mean age of the patients was 32.6±9.3 years and the receipt of injection from chemists (76%) was the most common risk factor for HBV infection among the subjects. About 67% of the patients were asymptomatic while 90.5% had normal liver span. Patients with low serum albumin, raised serum alkaline phosphatase, bilirubin and globulin prior to lamivudine therapy had restoration to normal values after 24 weeks of therapy. There was prolongation of prothrombin time (five patients) and hypokalaemia (one patient) after lamivudine therapy but there were no changes in the HBsAg, anti-HIV and anti-HCV status of all the patients. Although, post therapy liver biopsy was declined by 8 patients and contraindicated in 5 patients, there was 48% reduction in Knodell score of histologic findings in the liver biopsy specimens of 8 patients who had pre- and post-lamivudine therapy liver biopsies.

CONCLUSION

The findings from this study suggested that six-month therapy with lamivudine is beneficial in treating Nigerian patients with CHB using biochemical markers and liver histology in assessing response to treatment.

Multiple intracranial tuberculomas in an HIV-negative 28 year old male--a case report

Intracranial tuberculomas are uncommon complications of tuberculosis, especially in immuno-competent individuals with no evidence of extra-cranial foci. We report a case of an HIV- negative young male who presented with presumed cerebral and cerebellar tuberculomas without identifiable extra-cranial focus. The CT scan revealed multiple intracranial ring-enhanced lesions. The remarkable response to antituberculous drugs and steroid (prednisolone) with near complete resolution of clinical and radiological signs was highly suggestive of diagnosis. In the differential diagnosis of intracranial mass lesions in sub-Saharan Africa, a high index of clinical suspicion is needed to avoid misdiagnosis of intracranial tuberculoma.