Basic Physician Trainee at Flinders Medical Centre, South Australia.
Diabetes Mellitus Presenting As Epilepsia Partialis Continua
Mimi Wong, Cairns Hospital, Queensland, Australia
Ben Vogler, Cairns Hospital, Queensland, Australia
Aim: To describe the association between hyperglycaemia and seizure disorders.
Methods: Consent was obtained from the patient to present this case report.
Results: A 54 year old male labourer with no prior medical history presented with a 2-week history of painful right arm spasms with progressive weakness. There had been 15 kilograms of unintentional weight loss over the preceding month with associated polyuria and polydipsia.
Initial examination was remarkable for isolated weakness of the right upper limb with preservation of sensory modalities. Screening blood tests showed non-ketotic hyperglycaemia (BGL 40). Due to the suspicion of a focal seizure disorder with associated Todd’s paresis, an electroencephalogram was arranged and demonstrated epileptiform discharges in the left central region. An MRI of his brain showed evidence of bifrontal and bitemporal encephalomalacia suggestive of previous traumatic brain injury. He was commenced on both insulin and antiepileptic drug therapies with improvement of glycaemic control, resolution of right arm focal seizures, and gradual recovery of right arm strength.
An association between autoimmune diabetes and seizure disorder has been described in the literature, particularly with GAD antibody positivity. Although he appeared to have latent autoimmune diabetes of adulthood, his GAD, IA2, and insulin antibody were negative. Amongst children and patients presenting with fulminant type 1 diabetes, autoantibody screen may however be negative (1). It is possible though that metabolic derangements associated with hyperglycaemia could have led to his presentation of focal seizures (2).
Conclusion: In patients presenting with seizures and a new diagnosis of diabetes, an autoimmune phenomenon should be considered, though the metabolic disturbance associated with hyperglycemia may result in seizure presentation.
1. Brooks-Worrell, B. M., Reichow, J. L., Goel, A., Ismail, H., & Palmer, J. P. (2011). Identification of autoantibody-negative autoimmune type 2 diabetic patients. Diabetes Care, 34(1),168-73.
2. Hennis, A., Corbin, D., & Fraser, H. (1992). Focal seizures and non-ketotic hyperglycaemia. Journal of Neurology, Neurosurgery, and Psychiatry, 55(3), 195-7.