Cold shiver and piloerection are rare ictal signs in focal epilepsies. They are often associated with an epileptic seizure focus within the temporal lobe. In rare cases the phenomenon of piloerection has been reported to be confined to body parts ipsilateral to the seizure focus. In this multicentric study epilepsy patients with ictal cold shiver and/or piloerection were retrospectively asked to describe exactly location and spreading patterns of these signs as well as their temporal sequence in relation to other ictal signs. Clinical data, etiology of epilepsy, and seizure focus location were also assessed. In our patient group there was a high relationship to an epileptic focus within the left temporal lobe. Distinct spreading patterns or unilateral piloerection was not indicative of a focus in the ipsilateral temporal lobe as described previously. Our results suggest that phenomena of temperature dysregulation during epileptic seizures may be of value in the presurgical evaluation as they may be indicative of a left temporal lobe seizure focus.

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PubMed2003

Effect of human immunodeficiency virus on intensive care unit outcome of patients with Guillain-Barré syndrome.

OBJECTIVES: The primary objective of this study was to investigate the effect of human immunodeficiency virus (HIV) infection on the outcome of patients admitted to the intensive care unit (ICU) with severe Guillain-Barré syndrome (GBS) requiring mechanical ventilation. A secondary objective was to compare the clinical and laboratory features of HIV-seronegative and HIV-seropositive patients admitted to the ICU with severe GBS. DESIGN: Retrospective chart review. SETTING: Two tertiary, academic hospitals in Johannesburg, South Africa. MATERIALS AND METHODS: The case records of all patients admitted to the ICU with GBS between January 1995 and June 2002 were reviewed. Patients were included if their HIV status was known and if they had clinical features, electrophysiologic studies, and cerebrospinal fluid analyses consistent with GBS. Demographic data, days in ICU, days ventilated, CD4 T-lymphocyte counts (in the HIV group), cerebrospinal studies, infection rate, and mortality data were analyzed. RESULTS: A total of 13 patients met the inclusion criteria: seven were HIV seronegative and six were HIV seropositive. The median age in the HIV group was 34.5 yrs, compared with 47 yrs in the non-HIV group. There was no significant difference between the two groups in days spent in the ICU or days ventilated. There were no significant differences in cerebrospinal studies, electrophysiologic studies, and blood culture-positive infections between the two groups. All patients received intravenous immunoglobulin (0.4 g/kg/day for 5 days). There was one death in the HIV-seropositive group and no deaths in the HIV-seronegative group. The median CD4 T-lymphocyte count in the HIV group was 322.5 x 106 cells/L. CONCLUSION: HIV is commonly associated with GBS in South Africa. The ICU outcome in patients with HIV-associated GBS is similar to HIV-seronegative patients, particularly if the CD4 T-lymphocyte count is greater than 200 x 106 cells/L at admission.

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