Non-ketotic hyperglycaemia presenting as epilepsia partialis continua

Area of Science:

• Neurology
• Endocrinology
• Radiology

Background:

• Epilepsia partialis continua (EPC) is a rare epileptic syndrome often linked to brain lesions or metabolic issues.
• Non-ketotic hyperglycemia (NKH) is a serious metabolic disorder typically seen in elderly individuals.

Observation:

• An 83-year-old woman presented with persistent left facial twitching, diagnosed as EPC.
• Initial investigations revealed significantly elevated serum glucose (631 mg/dl), osmolality (310 mOsm/l), and normal EEG.
• Brain MRI demonstrated focal signal abnormalities in the right frontal lobe.

Findings:

• The patient's EPC resolved completely after correcting hyperglycemia, hydration, and valproate treatment.
• Follow-up MRI six months later showed complete resolution of the brain lesions.
• This case highlights the reversible nature of focal brain lesions in NKH-induced EPC.

Implications:

• Early diagnosis and management of NKH are crucial for preventing long-term neurological sequelae in elderly patients.
• This case underscores the importance of considering metabolic disorders, particularly NKH, in the differential diagnosis of new-onset seizures in the elderly.
• Reversible focal brain lesions on MRI associated with NKH-induced EPC suggest a treatable etiology.