Seizures in patients with idiopathic hypoparathyroidism: effect of antiepileptic drug withdrawal on recurrence of seizures and serum calcium control

Abstract

Objective: There is limited information on seizures in patients with idiopathic hypoparathyroidism (IH). We assessed seizure characteristics at presentation, subclinical seizures during follow-up, and the effect of antiepileptic drug (AED) withdrawal in IH patients. Designs and methods: Seizure characteristics were assessed in 70 patients with IH attending endocrine clinic. Provoked electroencephalography (EEG) was performed for subclinical seizures in 44 of them. AEDs were withdrawn using strict criteria, i.e. i) no seizure during past 2 years, ii) normal EEG, iii) serum total calcium R1.8 mmol/l, and iv) feasibility to follow-up regularly after AED withdrawal for at least 9 months (nZ14). The effects of AED withdrawal on seizures and serum total calcium were assessed. Results: Seizures were present in 64.3% of patients, generalized tonic-clonic in 86.7%, and treated with phenytoin (46.7%), valproate (40%), and carbamazepine (26.7%). Most (69/70) patients were seizure-free during the follow-up of 6.6G4.5 years. Ten of 14 (71.4%) patients were successfully withdrawn from AED and remained seizure free during the follow-up period of 13.5G2.4 months (range 9-18). AEDs were restarted because of the recurrence of seizures (nZ3) and poor compliance with calcium/vitamin D (nZ1). The mean serum total calcium increased from 1.9G0.19 to 2.1G0.14 mmol/l after AED withdrawal (PZ0.004). Conclusion: Seizures were present in 64.3% of patients with IH and they responded to AED and calcium/1-a-(OH)D during the follow-up. With strict eligibility criteria, it was possible to withdraw AED in 71% of patients with IH. Serum total calcium improved significantly after AED withdrawal.

Epileptic seizure, as the first symptom of hypoparathyroidism in children, does not require antiepileptic drugs

“…Treatment of these diseases must focus on calcium supplementation and not on the invalid AED therapy. Our results are consistent with the study of Modi et al [10], who indicated that patients with hypoparathyroidism could reach optimal seizure outcomes regardless of the use of AEDs. Although adult patients were included in their study, patients with seizures as the first manifestation were mainly in their childhood; this trend was similar among our included patients.…”

Clinical and genetic characteristics of Pseudohypoparathyroidism in the Chinese population

“…The results of the present study include descriptions of the prevalence of chronic complications in the Asian PHP population. Cataracts and intracranial calcification are common chronic complications of hypoparathyroidism and have been observed in 75%‐97.7% and 60%‐70%, respectively, of idiopathic hypoparathyroidism patients. These complications are related to duration of disease and Ca/P ratio .…”

Effect of basal ganglia calcification on its glucose metabolism and dopaminergic function in idiopathic hypoparathyroidism

“…The diagnosis of IH was based on hypocalcaemia, hyperphosphataemia and low intact parathyroid hormone (iPTH). 1,7,8 None of the study patients had mutation of the calcium sensing receptor (CASR) or PTH gene. However, GCM2 (R110W) mutation was present in two of them.…”

“…The clinical and biochemical features of the cohort and their daily calcium carbonate (1-2 gm of elemental calcium) and 1,a-(OH)D (0Á5-2Á0 lg) therapy were similar to that reported earlier. 1,7,8 Details of cognitive, psychiatric and neurological assessment and abnormalities observed in 27 of 35 study subjects were reported recently. 6 The procedure adopted for assessment of other subjects was essentially the same as described earlier 6 and is briefly given in the supplement information (Please see Data S1).…”

“…Serum iPTH was measured using IRMA till 2006 (DiaSorin; NR: 13-54 ng/l) and subsequently by chemiluminescence (Elecsys-2010, Roche; NR: 15-65 ng/l) in the endocrine service laboratory as reported earlier. 1,8 Statistical analysis…”