Letter to the Editor
Occipital epilepsia partialis continua induced by non-ketotic hyperglycaemia
Epilepsia parcial continua con foco occipital inducida por hiperglucemia no cetósica
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Garzo Caldas, E. Gomez Cibeira, R.A. Saiz Díaz, A. Herrero Sanmartín" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Garzo Caldas" "email" => array:1 [ 0 => "nicolas.garzo@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Gomez Cibeira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R.A." "apellidos" => "Saiz Díaz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Herrero Sanmartín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epilepsia parcial continua con foco occipital inducida por hiperglucemia no cetósica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 730 "Ancho" => 2500 "Tamanyo" => 346281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">EEG traces obtained before and after onset of insulin therapy. The first trace shows asymmetrical alpha activity, which is absent in the second.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Numerous neurological manifestations of glycaemic alterations have been described, with hypoglycaemia being a well-known cause of epileptic seizures.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It is less well known that neurological symptoms may present as the initial manifestation of hyperglycaemia,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> with epilepsia partialis continua being a characteristic form; these patients usually present focal motor seizures, unlike those with hypoglycaemia.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Hyperosmolar non-ketotic hyperglycaemia is the type of hyperglycaemia most frequently associated with these symptoms, and is occasionally the initial manifestation of undiagnosed diabetes mellitus.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> The specific pathophysiological mechanism underlying this association is not fully understood, and ketosis may protect against seizures in patients with hyperglycaemia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> We present the case of a patient with occipital epilepsia partialis continua in the context of non-ketotic hyperglycaemia, resolving with metabolic control. This case underscores the need to consider this entity, which, though rare, has considerable therapeutic and prognostic implications.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 61-year-old man with hypertension, dyslipidaemia, and type 2 diabetes mellitus, which had previously been well controlled. He was being treated with telmisartan, simvastatin, fenofibrate, metformin, acetylsalicylic acid, and omeprazole. He had no history of seizures or any other relevant history. He began to present simple visual hallucinations of sparkling lights; onset was sudden and episodes were of variable duration (seconds to hours). Visual hallucinations affected both eyes and the entire visual field, and persisted when the eyes were closed. He reported reversal of vision metamorphopsia when the symptoms initially presented, although this resolved spontaneously. The patient presented no visual field deficits, headache, or any other focal neurological sign. These symptoms had progressed for 20 days before the patient consulted the department; the frequency of the episodes ranged from 5 to 20 per day, with no defined temporal or circadian pattern.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Neurological examination revealed no focal neurological deficits. A complete blood count revealed a glucose level of 382<span class="elsevierStyleHsp" style=""></span>mg/dL, with 14% glycated haemoglobin. The only other alteration detected was known hypertriglyceridaemia. Results for ketone bodies were negative. The patient displayed EEG asymmetry, with abnormal occipital alpha waves in the right hemisphere (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The brain MRI study revealed T2 hyperintensity and diffusion restriction in the right occipital cortex, with T2 hypointensity in the adjacent subcortical region (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We also performed a head and neck MRI angiography and a transcranial and supra-aortic trunk Doppler ultrasound study, with no relevant findings. Insulin therapy was started and the visual symptoms resolved within hours and have not recurred to date (15 months of follow-up), with the patient presenting optimal glycaemic control. Findings from subsequent EEG and MRI studies were normal (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Antiepileptic drugs were not administered at any time.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Occipital epileptic seizures are rare in patients with hyperglycaemia<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a>; in recent years, they have been linked to characteristic MRI findings, such as subcortical hypointensities on T2-weighted sequences and diffusion restriction in the occipital cortex.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6–8</span></a> The pathophysiological mechanism underlying this association remains unknown, although it has been suggested that abnormal iron deposition may play a role.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> The resolution of clinical, radiological, and EEG signs after onset of diabetes treatment is essential to diagnosis, avoiding unnecessary complementary tests and the introduction of chronic antiepileptic treatment and the associated consequences.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garzo Caldas N, Gomez Cibeira E, Saiz Díaz RA, Herrero Sanmartín A. Epilepsia parcial continua con foco occipital inducida por hiperglucemia no cetósica. Neurología. 2020;35:437–439.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This study was presented as a poster at the 15th Annual Meeting of the Madrid Association of Neurology, held in October 2017.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 730 "Ancho" => 2500 "Tamanyo" => 346281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">EEG traces obtained before and after onset of insulin therapy. The first trace shows asymmetrical alpha activity, which is absent in the second.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1523 "Ancho" => 1583 "Tamanyo" => 175583 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI study. (A) T2-weighted sequence showing hyperintensity in the right visual cortex and adjacent subcortical hypointensity. (B) Diffusion-weighted sequence showing an area of restricted diffusion in the right visual cortex. (C and D) T2- and diffusion-weighted sequences obtained after onset of insulin therapy, showing total resolution of the alterations.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seizures as the only clinical manifestation of reactive hypoglycemia: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Monami" 1 => "E. Mancucci" 2 => "A. Breschi" 3 => "N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 10 | 3 | 13 |
| 2024 September | 26 | 4 | 30 |
| 2024 August | 24 | 5 | 29 |
| 2024 July | 24 | 5 | 29 |
| 2024 June | 17 | 8 | 25 |
| 2024 May | 20 | 11 | 31 |
| 2024 April | 15 | 3 | 18 |
| 2024 March | 24 | 2 | 26 |
| 2024 February | 12 | 5 | 17 |
| 2024 January | 14 | 4 | 18 |
| 2023 December | 17 | 6 | 23 |
| 2023 November | 15 | 10 | 25 |
| 2023 October | 19 | 10 | 29 |
| 2023 September | 6 | 1 | 7 |
| 2023 August | 20 | 4 | 24 |
| 2023 July | 31 | 1 | 32 |
| 2023 June | 41 | 9 | 50 |
| 2023 May | 71 | 5 | 76 |
| 2023 April | 59 | 1 | 60 |
| 2023 March | 10 | 8 | 18 |
| 2023 February | 19 | 4 | 23 |
| 2023 January | 8 | 8 | 16 |
| 2022 December | 30 | 4 | 34 |
| 2022 November | 25 | 4 | 29 |
| 2022 October | 22 | 12 | 34 |
| 2022 September | 20 | 8 | 28 |
| 2022 August | 25 | 14 | 39 |
| 2022 July | 15 | 8 | 23 |
| 2022 June | 15 | 7 | 22 |
| 2022 May | 31 | 6 | 37 |
| 2022 April | 11 | 14 | 25 |
| 2022 March | 21 | 13 | 34 |
| 2022 February | 23 | 5 | 28 |
| 2022 January | 36 | 8 | 44 |
| 2021 December | 40 | 7 | 47 |
| 2021 November | 19 | 19 | 38 |
| 2021 October | 15 | 12 | 27 |
| 2021 September | 27 | 18 | 45 |
| 2021 August | 14 | 9 | 23 |
| 2021 July | 12 | 10 | 22 |
| 2021 June | 10 | 14 | 24 |
| 2021 May | 13 | 6 | 19 |
| 2021 April | 78 | 23 | 101 |
| 2021 March | 33 | 6 | 39 |
| 2021 February | 19 | 11 | 30 |
| 2021 January | 13 | 9 | 22 |
| 2020 December | 14 | 9 | 23 |
| 2020 November | 10 | 6 | 16 |
| 2020 October | 9 | 6 | 15 |
| 2020 September | 11 | 11 | 22 |
| 2020 August | 18 | 9 | 27 |
| 2020 July | 5 | 10 | 15 |
| 2020 June | 0 | 8 | 8 |
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