Seizures during treatment of Vitamin B12 deficiency

Abstract

Epileptic seizures during infancy have a wide variety of clinical presentations and the outcome differs according to the etiology. Among the benign and rare causes of infantile seizures, Vitamin B12 deficiency has been encountered. Common symptoms of Vitamin B12 deficiency in infants include megaloblastic anemia, feeding difficulties, developmental delay, microcephaly, failure to thrive, hypotonia, lethargy, irritability, involuntary movements, seizures and cerebral atrophy. Involuntary movements and seizures may rarely be the initial symptoms of Vitamin B12 deficiency. Involuntary movements have also been reported to appear after initiation of Vitamin B12 supplementation in isolated cases, whereas, no such information exits for seizures. In this paper, three infants with Vitamin B12 deficiency associated with motor and mental retardation are reported because of long-lasting focal/multifocal epileptic seizures following the initiation of intramuscular Vitamin B12 treatment. Antiepileptics were introduced in addition to Vitamin B12. Seizures disappeared within a few days or weeks; electroencephalographic findings were normalized in a few months. No relapses occurred during the follow-up period.

Long-term outcome in children with nutritional vitamin B12 deficiency

“…Cortical atrophy, thinning of the corpus callosum, and retarded myelination have been reported as neuroradiological imaging findings in patients with vitamin B12 deficiency [35,36]. In the present study 4 patients developed involuntary movements during vitamin B12 treatment; it has been reported that such movements rarely occur during vitamin B12 treatment [37,38], although its mechanism is not fully known.…”

Involuntary movements during vitamin B12 treatment in infants

“…Although it has been proposed that hyperglycinemia is responsible for the involuntary movement observed in response to vitamin B12 treatment [7], it was also reported that glycine levels were normal [11]. It was reported that EEG results in patients with seizures due to vitamin B12 deficiency were abnormal, whereas normal EEG results were observed in patients with tremors and myoclonus [1,12,13,16]. As such, it was reported that use of antiepileptics was unnecessary and useless in patients with involuntary movements [1,10,16].…”

“…It was reported that EEG results in patients with seizures due to vitamin B12 deficiency were abnormal, whereas normal EEG results were observed in patients with tremors and myoclonus [1,12,13,16]. As such, it was reported that use of antiepileptics was unnecessary and useless in patients with involuntary movements [1,10,16]. It is thought that involuntary movements is self-restricted and there is no consensus on the use of antiepileptic treatment [7,10].…”

“…Data concerning the longterm prognosis of neurological symptoms due to vitamin B12 deficiency are inadequate. Although hematological symptoms varying from megaloblastic anemia to pancytopenia can be cured, neurological symptoms may persist [4,16,18]. Some studies reported no improvement in verbal or psychomotor ability despite vitamin B12 treatment, which suggests that neurological impairment may be irreversible if the diagnosis is delayed beyond 12 months [18,19].…”

Paroxysmal disorders in children receiving substitution therapy with vitamin B12

“…В статье G. Benbir и соавт. (2005) описаны 3 случая появления эпилептических приступов у детей после заместитель-ного введения витамина В 12 [4]. В этих клинических наблюдениях помимо задержки развития разной сте-пени тяжести у детей в период терапии витамином В 12 регистрировались эпилептические приступы по типу миоклонических и клонических, сопровождавшиеся наличием иктальных и интериктальных региональных или мультирегиональных эпилептиформных измене-ний на электроэнцефалограмме (ЭЭГ) вплоть до эпи-лептического статуса.…”