Overrepresentation of epilepsy in children with type 1 diabetes is declining in a longitudinal population study in Finland

Sillanpää, Matti; Saarinen, Maiju; Rönnemaa, Tapani; Gissler, Mika; Schmidt, Dieter

doi:10.1111/apa.14910

Cited by 4 publications

(8 citation statements)

References 28 publications

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“…Diabetic children develop epilepsy 2-3 times more commonly than normoglycaemic controls [ 144 , 145 , 149 , 150 ]. Younger age at diabetes onset is the main risk factor [ 144 ].…”

Section: Resultsmentioning

confidence: 99%

Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review

Bartolini

Ferrari

Fiori

et al. 2023

JCM

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Cerebral excitability and systemic metabolic balance are closely interconnected. Energy supply to neurons depends critically on glucose, whose fluctuations can promote immediate hyperexcitability resulting in acute symptomatic seizures. On the other hand, chronic disorders of sugar metabolism (e.g., diabetes mellitus) are often associated with long-term epilepsy. In this paper, we aim to review the existing knowledge on the association between acute and chronic glycaemic imbalances (hyper- and hypoglycaemia) with seizures and epilepsy, especially in the developing brain, focusing on clinical and instrumental features in order to optimize the care of children and adolescents and prevent the development of chronic neurological conditions in young patients.

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“…Diabetic children develop epilepsy 2-3 times more commonly than normoglycaemic controls [ 144 , 145 , 149 , 150 ]. Younger age at diabetes onset is the main risk factor [ 144 ].…”

Section: Resultsmentioning

confidence: 99%

Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review

Bartolini

Ferrari

Fiori

et al. 2023

JCM

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“…Overall, ten datasets from six observational studies were included in the meta-analysis [24][25][26][27][28][29] . A significant heterogeneity was observed among the included studies (P for Cochrane Q test <0.001, I 2 = 95%).…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…After conducting full-text reviews of 22 studies, 16 were excluded due to the reasons specified in Figure 1. Consequently, six studies were deemed suitable for the subsequent metaanalysis [24][25][26][27][28][29] .…”

Section: Resultsmentioning

confidence: 99%

Type 1 diabetes and the risk of epilepsy: A meta‐analysis

Wu,

Ding

2023

J of Diabetes Invest

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Aims/IntroductionAn overrepresentation of epilepsy has been suggested in patients with type 1 diabetes (T1D). This meta‐analysis was conducted to evaluate if type 1 diabetes is associated with a higher incidence of epilepsy.Materials and MethodsLongitudinal observational studies which are relevant to the purpose of the meta‐analysis were screened and obtained by searching PubMed, Embase, and Web of Science databases. Random‐effects models were used when significant heterogeneity was observed; otherwise, fixed‐effects models were used.ResultsSix observational studies involving 10 datasets of 8,001,899 participants were included, with six datasets including children and only one dataset including older people. Among them, 100,414 (1.25%) had type 1 diabetes. During the follow‐up duration of 5.4–15.2 years (mean: 9.5 years), 98,644 cases (1.23%) of epilepsy were observed. Compared with participants with normoglycemia, those with type 1 diabetes were shown to have a higher incidence of epilepsy (risk ratio [RR]: 2.41, 95% confidence interval 1.69–3.44, P < 0.001; I2 = 95%) after adjustment of potential confounding variables including age and sex. Subgroup analysis showed consistent results in nested case–control and retrospective cohort studies, and in studies of children, non‐elderly adult, and older participants (P for subgroup difference = 0.42 and 0.07). In addition, a stronger association of type 1 diabetes and epilepsy was suggested in studies with follow‐up duration <10 years compared with those ≥10 years (RR: 3.34 vs 1.61, P for subgroup difference < 0.001).ConclusionPatients with type 1 diabetes may have a higher risk of epilepsy, which was mainly driven by datasets including children.

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“…Several factors such as a young age, severe hypoglycemia, and diabetic ketoacidosis (DKA) were considered to influence epileptiform abnormalities. While no predictive value of these discharges on a clinical diagnosis, i.e., epilepsy, has been reported, the prevalence of epilepsy was found to be increased in adults and children in large cohort studies and a meta-analysis of T1DM [ 24 – 26 ]. Genetic predispositions, the effects of hypoglycemia/hyperglycemia, and vascular damage in the brain may have caused these 2 concomitant disorders [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Electroencephalographic abnormalities in children with type 1 diabetes mellitus: a prospective study

YILDIRIM,

GÜNBEY

2023

Turkish Journal of Medical Sciences

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Background/aim The aim herein was to investigate epileptiform discharges on electroencephalogram (EEG), their correlation with glutamic acid decarboxylase 65 autoantibody (GAD-ab) in newly diagnosed pediatric type 1 diabetes mellitus (T1DM) patients and interpret their medium-term utility in predicting epilepsy. Materials and methods Children presenting with T1DM between July 2018 and December 2019 were included in this prospective longitudinal study. Patients with a history of head injury, chronic illness, neurological disorder, seizure, autism, or encephalopathy were excluded. EEGs were obtained within the first 7 days of diagnosis and later reviewed by a pediatric neurologist. All of the children were clinically followed-up in pediatric endocrinology and neurology clinics for 2 years after their diagnosis. Results A total of 105 children (46 male, 43.8%) were included. The mean age at the time of diagnosis was 9.6 ± 4.1 years (range: 11 months–17.5 years). At the time of admission, 24 (22.9%), 29 (27.6%), and 52 (49.5%) patients had hyperglycemia, ketosis, and diabetic ketoacidosis, respectively. GAD-ab was positive in 55 children (52.4%). No background or sleep architecture abnormalities or focal slowing were present on the EEGs. Of the patients, 3 (2.9%) had focal epileptiform discharges. The mean GAD-ab levels of the remaining 102 patients were 7.48 ± 11.97 U/mL (range: 0.01–50.54) (p = 0.2). All 3 children with EEG abnormality had higher levels of GAD-ab (3.59 U/mL, 31.3 U/mL, and 7.09 U/mL, respectively). None of the patients developed epilepsy during the follow-up, although 1 patient experienced Guillain–Barré syndrome (GBS). Conclusion The prevalence of epileptiform discharges in the patients was similar to those of previous studies, in which healthy children were also included. No relationship was found between the epileptiform discharges and GAD-ab, and none of the patients manifested seizures during the first 2 years of follow-up of T1DM. These data support the findings of previous studies reporting that T1DM patients with confirmed electroencephalographic abnormalities do not have an increased risk of epilepsy. On the other hand, GBS might be considered as another autoimmune disease that may be associated with T1DM in children.

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Overrepresentation of epilepsy in children with type 1 diabetes is declining in a longitudinal population study in Finland

Cited by 4 publications

References 28 publications

Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review

Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review

Type 1 diabetes and the risk of epilepsy: A meta‐analysis

Electroencephalographic abnormalities in children with type 1 diabetes mellitus: a prospective study

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