[Continuous partial epilepsy disclosing diabetes mellitus].
Continuous partial epilepsy (CPE) is characterized by isolated, subintrant clonus focalized to a limited territory with critical focal electroencephalography in a concordant territory. CPE is observed in various cortical lesions but also in disorders of metabolism and notably decompensated diabetes mellitus. We report a case of CPE without focal lesion at MRI which revealed hyperglycaemia without ketosis. The 54-year old female patient was hospitalised for C.P.E.. Early CT and later MRI gave normal results. Biochemistry showed hyperglycaemia without kenoturia, acidosis or hyperosmolality. Insulin therapy rapidly brought glycaemia down to its normal level and the clonsism disappeared. Five months later, the patient had no other seizure and the EEG was normal. Epileptic seizures are frequent in hyperglycaemia without ketosis (25% of the cases) where they are mainly partial and motor (75 to 86% of the cases), rarely associated with a focal lesion (15% of the cases with CT scan). They are rare in patients with ketoacidosis. This apparent protective effect of ketoacidosis may be attributed to an increase of GABA bioavailability consecutive to acidosis. CPE is resistant to antiepileptic treatments. In CPE induced by hyperglycaemia without ketosis normalization of blood glucose level with insulin therapy is concomitant with a rapid cure of epilepsy. Thus glycaemia should be measured in all patients presenting with CPE, the aim being to diagnose hyperglycaemia without ketosis rapidly to avoid hyperosmolality and to prescribe an adequate treatment based exclusively on insulin and rehydration.
Cochin
J P
JP
Clinique Neurologique, CHU Charles-Nicolle, Rouen.
Hannequin
D
D
Delangre
T
T
Guegan-Massardier
E
E
Augustin
P
P
D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008875:Middle Aged; D016896:Treatment Outcome
D007328:Insulin
Epilepsie partielle continue révélatrice d'un diabète sucré.