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Focal epilepsy in diabetic non-ketotic hyperglycaemia.

1985; BMJ; Volume: 290; Issue: 6476 Linguagem: Inglês

10.1136/bmj.290.6476.1204

0959-8138

Connor Grant, C Warlow,

Diet and metabolism studies

In non-insulin-dependent diabetes mellitus hyperglycaermia without ketosis may be present for months or years before the disease becomes overt.We report five patients, four of whom were not previously known to have diabetes, who presented with focal epilepsy resistant to anticonvulsants.Unsuspected hyperglycaemia was discovered during investigation.Treatment of the diabetes with insulin or sulphonylurea drugs abolished the focal convulsions, for which no other cause was identified.None of the patients was ketotic, and we suggest that seizures such as these may signal the gradual approach of hyperosmolar coma when treatment is still comparatively straightforward.The danger is that the diagnosis of diabetes may be missed in a patient presenting with newly acquired focal epilepsy. Case reportsCase I-A 78 year old shepherd presented with focal motor seizures of the left arm which had increased in frequency and severity over three days.He remained alert during the seizures, each of which lasted about a minute and left a transient flaccid weakness and sensory loss in the arm.Examination showed nothing else of note.On admission he had a blood glucose concentration of 46-5 mmol/l (838 mg/100 ml) but no ketonuria.Rehydration, insulin, and phenytoin were started and within 24 hours the seizures had stopped.In retrospect he recalled having polyuria and polydipsia.Computed tomography (CT) of the head showed normal appearances; electroencephalography was not performed.His diabetes was controlled with chlorpropamide alone.The phenytoin was withdrawn after 11 days, and when last seen he had been free of seizures for five years.Case 2-A 66 year old housewife presented after four days of episodic jerking of her left arm, having suffered headaches, diplopia, and clumsiness of the left hand for a week.She also reported a weight loss of 9 kg over 18 months.On admission she was having repeated focal motor seizures of the left arm and left side of the face lasting two or three minutes with no loss of awareness.Between seizures there was flaccid weakness, pronounced ataxia, and sensory loss in the left arm and left facial weakness.General examination findings were normal.Her blood glucose concentration reached 33 mmol/l (595 mg/100 ml) but there was no ketonuria.Cerebrospinal fluid, electro- encephalogram, and CT scan were normal.The diabetes was treated and she was given phenytoin, but the seizures stopped only when the hyper- glycaemia had responded to insulin.All her neurological signs disappeared in a few days and the phenytoin was withdrawn after a month.Four years