Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia: case report

Abstract

-We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia.KEY WORDS: aphasia, seizures, diabetes mellitus. Crises parciais complexas e afasia como manifestações iniciais de hiperglicemia não cetótica: relato de casoRESUMO -Descrevemos um caso de hiperglicemia não-cetótica (HNC) cujas manifestações iniciais foram crises parciais complexas e afasia de origem epiléptica, além de crises versivas e parcias motoras. Este quadro clínico foi acompanhado por atividade epileptiforme na região fronto-temporal esquerda ao eletrencefalograma. As crises epilépticas foram controladas com carbamazepina (CBZ) apenas após o controle do diabetes mellitus. Após um mês, a CBZ foi suspensa, permanecendo a paciente com linguagem normal, sem novas crises epilépticas, em uso apenas de glibenclamida. Crises parciais complexas, ao contrário de crises parciais simples, são raramente descritas como manifestação de HNC. Atividade epileptiforme nas regiões relacionadas a linguagem podem manifestar-se como afasia. PALAVRAS-CHAVE: epilepsia, crises epilépticas, diabetes mellitus, afasia.Non-ketotic hyperglycemia (NKH) is classically associated to simple partial seizures and partial motor status epilepticus (SE) and rarely to complex partial seizures (CPS) 1,2 . We present a case that was heralded by CPS and aphasia of epileptic origin, before systemic signs and symptoms of diabetic decompensation. CASE REPORTA 60 year old black woman, right-handed, was brought by relatives to the neurological emergency room because of altered behaviour for a week. She presented irritation and moments of staring, that seemed to "turn off", stopping domestic work. At other times, she stopped speaking, or forgot the names of her relatives and objects, answering only monosyllables. Besides these episodes, she looked completely well. The patient and relatives denied other neurologic and systemic complaints, including fever, polyphagia, polydipsia, polyuria and Escola Paulista

Seizures in nonketotic hyperglycaemia

“…Interestingly, we found 2 (8.7%) of our patients presented with CPS. Our finding confirmed previous reports of CPS induced by hyperglycaemia 4 . The mechanism of seizures in NKH is still debated.…”

Untitled

“…Neurological Manifestations of Hyperosmolar Hyperglycemic State: A Case Report and A Review of the Literature Batista et al [7] 1.…”