title: Comorbidity and metabolic context are crucial factors determining neurological sequelae of hypoglycaemia.
abstract: OBJECTIVE
  To determine risk factors for neurological sequelae following hypoglycemia.
  
  
  METHODS
  We analysed the neurological outcome in 164 patients (mean age 10y 10mo, SD 5.9) following hypoglycemia due to three diseases with various metabolic contexts, different ages at onset, and combinations with comorbidity (fever/infection, hypoxia/ischemia): glycogen storage disease type I (GSDI) (21 patients, mean age at first hypoglycemic episode 3.8mo, SD 3.5); fatty acid β-oxidation defects (FAOD) (29 patients, mean age at first hypoglycemic episode 14.8mo, SD 12.6); and hyperinsulinism (HIns) (114 patients, mean age at first hypoglycemic episode 2.3mo, SD 4.7).
  
  
  RESULTS
  Risk factors of poor neurological outcome were aetiology (p<0.006), comorbidity (p<0.001), and prolonged convulsions (p<0.001). Ordinal logistic regression showed that comorbidity (p<0.001) and status epilepticus (p=0.002) were the main determinants of sequelae. Asymptomatic hypoglycemia did not lead to sequelae, whatever the aetiology. Age was not correlated to sequelae, whatever the aetiology. The highest prevalence of hypoglycemic sequelae was found in FAOD and HIns combined with comorbidity, the lowest in GSDI (p<0.001) in which hypoglycemia is often asymptomatic, associated with increased plasma lactate, and rarely combined with comorbidity.
  
  
  CONCLUSIONS
  Hypoglycemia is severely deleterious for the brain in the context of fever/infection and/or hypoxia/ischemia, and status epilepticus. The metabolic context providing alternative fuels may improve neurological outcome.
authors.affiliation: Neuropediatrics Department, Necker-Enfants Malades Hospital, Paris, France.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Gataullina
authors.forename: Georges
authors.initials: G
authors.lastname: Dellatolas
authors.forename: Hervé
authors.initials: H
authors.lastname: Perdry
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Robert
authors.forename: Vassili
authors.initials: V
authors.lastname: Valayannopoulos
authors.forename: Guy
authors.initials: G
authors.lastname: Touati
authors.forename: Chris
authors.initials: C
authors.lastname: Ottolenghi
authors.forename: Olivier
authors.initials: O
authors.lastname: Dulac
authors.forename: Pascale
authors.initials: P
authors.lastname: De Lonlay
mesh_terms: D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005953:Glycogen Storage Disease Type I / Q000150:complications; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications; D007003:Hypoglycemia / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D016015:Logistic Models; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012640:Seizures