Endocrine Abstracts

Introduction: When hypoglycemia is deep and repeated, it can induce various neurological disorders, including epileptic seizures. The link between hypoglycemia and epileptic phenomena is complex and poorly explained. We report 3 cases of epilepsy induced by repeated episodes of deep hypoglycemia.

Cases report: Mr D.M, 48 years old, with a history of 3 episodes of hypoglycemic coma, admitted for status epilepticus with a blood glucose level of 0.4 g/l; cerebral CT was normal. The encephalogram showed a slowing of the background rhythm with paroxysmal fronto-central bilateral anomalies. Biological test shows endogenous hypersecretion of insulin; echoendoscopy revealed an hypoechogenicity of 2 cm/2.5 cm at the head of pancreas. The second case is a 38-year-old patient treated for epilepsy for 2 years, admitted for a major generalized tonic-clonic seizure with left hemiplegia. MRI brain was normal, glycemia was at 0.3 g/l, insulin levels and peptide C were too high, an Octreoscan is required; an endocrine tumor of the pancreas secreting insulin is strongly suspected in these two patients. The third case is a 22-year-old patient, diabetic type 1, receiving insulin for 6 years, he has a history of hypoglycemic coma and he is hospitalized for a new episode revealed by generalized tonic-clonic seizures. The encephalogram showed a slowing of the background rhythm with paroxysmal fronto-central bilateral anomalies. Cerebral MRI showed an hypersignal in T1 and T2 of the basal ganglia.

Discussion: The deep hypoglycemia can induce convulsive crises as far as it can predisposes to the development of epileptogenic foci. The induced seizures are mainly generalized and tonic-clonic and the described abnormalities predominate in the frontal and temporal lobes, which joins the cases of our three patients.