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Non-ketotic hyperglycaemia presenting as epilepsia partialis continua
Ozlem Cokar1, Betül Aydin, Feriha Ozer
1Department of Neurology, Haseki Research and Educational Hospital, Istanbul, Turkey. ozlemcokar@hotmail.com
Seizure
|May 4, 2004
Summary
Epilepsia partialis continua (EPC) can be the first sign of hyperosmolar non-ketotic hyperglycemia (NKH) in elderly patients. Prompt diagnosis of this diabetic complication is crucial for effective seizure management.
Area of Science:
- Neurology
- Endocrinology
- Metabolic Disorders
Background:
- Epilepsia partialis continua (EPC) is a rare epileptic syndrome.
- It is associated with cortical lesions and metabolic disorders.
- Hyperosmolar non-ketotic hyperglycemia (NKH) is a serious diabetic complication.
Observation:
- A 57-year-old patient presented with EPC as the initial symptom of NKH.
- Brain imaging (CT and MRI) revealed no abnormalities.
- Laboratory results showed extremely high serum glucose (1540 mg/dl) and osmolality (391 mOsm/l).
Findings:
- Electroencephalography (EEG) demonstrated ictal discharges in the affected hemisphere during focal seizures.
- Anticonvulsant medications were ineffective.
- Seizures responded favorably to insulin therapy and rehydration.
Implications:
- Focal motor seizures or EPC can be an early indicator of NKH, particularly in older adults.
- Metabolic screening, including for diabetes mellitus, is essential in patients presenting with new-onset focal seizures or EPC.
- Early identification and management of NKH are critical for controlling seizures and preventing complications.