Focal Seizures As A Manifestation Of Hyperglycemia Without Ketoacidosis
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Seizures In Hyperglycemic Patients.
Abstract AIM OF STUDY: To study the pattern of seizures in hyperglycemic patients and its correlation with serum osmolality, blood sugar and serum sodium. MATERIALS AND METHODS: (Study period June 1999-June 2000) Forty patients who presented with first time seizures and who were detected to be diabetic were included in the study. All patients had detailed history, clinical examination blood sugar, BUN, serum electrolytes, serum osmolality, serum calcium estimation. EEG and CT head scan was also done. The seizures were classified as per ILAE classification (1981). The study group was further divided into Group A--those with normal CT (n 24) and Group B-- those showing infarcts in CT scan (n 16). The control group (n 40) were matched for age and had first occurrence of seizures and CT showed infarct and were euglycemic. All the investigations were done for the control group as well. Statistical analysis was done using ANOVA. RESULTS: None of the patient had diabetic ketoacidosis. Patients in study group had statistically significant incidence of (1) Focal seizures with or without generalisation (100%); (2) Visual hallucination (25%); (3) Epilepsia partialis continua (20%). Comparing the subgroups (A and B) complex partial seizures and visual hallucination was significant at 5% level in the group A (NKH with normal CT). Ninety percent in the study group had increased serum osmolality (Vs 22.5% in the control group). Duration (eight days Vs 1) and frequency (15 per day vs 1.45) were positively correlated with RBS > S.osmolality > S.sodium. CONCLUSION: 1. Long duration and frequent focal motor seizures with or without secondary generalisation occurs in NKH which at times may be the first manifestation of DM. 2. Complex partial seizures, visual hallucination and epilepsia par Continue reading >>
Not to be confused with the opposite disorder, hypoglycemia. Hyperglycemia, or high blood sugar (also spelled hyperglycaemia or hyperglycæmia) is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l (~250–300 mg/dl). A subject with a consistent range between ~5.6 and ~7 mmol/l (100–126 mg/dl) (American Diabetes Association guidelines) is considered slightly hyperglycemic, while above 7 mmol/l (126 mg/dl) is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time. Signs and symptoms The degree of hyperglycemia can change over time depending on the metabolic cause, for example, impaired glucose tolerance or fasting glucose, and it can depend on treatment. Temporary hyperglycemia is often benign and asymptomatic. Blood glucose levels can rise well above normal and cause pathological and functional changes for significant periods without producing any permanent effects or symptoms.  During this asymptomatic period, an abnormality in carbohydrate metabolism can occur which can be tested by measuring plasma glucose.  However, chronic hyperglycemia at above normal levels can produce a very wide variety of serious complications over a period of years, including kidney damage, neurological damage, cardiovascular damage, damage to the retina or damage to feet and legs. Diabetic n Continue reading >>
Can High Blood Sugar (hyperglycemia) Cause Seizures?
Seizures can be triggered by too low blood sugar (hypoglycemia) and maybe by too high blood sugar (hyperglycemia). But overall, they are commonly linked with a condition called epilepsy. Furthermore, they also can be a warning sign of other health conditions. What else you need to know about the truth of seizures and hyperglycemia? Seizure – what actually is it? To control the movement of your body, your brain needs to send some small electrical signals around the body. For this mechanism, your body is equipped with a lot of nerves – these nerves acts as carrier for those signals. Theoretically, seizure occurs when the brain sends abnormal /wrong signals which then eventually can affect the way of the body’s function. Epilepsy is the most popular problem of nervous system that often linked with seizure. And it can affect people of all ages. But as written before, epilepsy is not the single reason of this symptom. The following are other health conditions that also can be potential to cause seizure: Toxoplasmosis or tapeworm (this is a kind of parasitic infection). Encephalitis or meningitis sometime also can trigger seizures. Certain health conditions that have developed since birth (connatural problems)! Imbalance glucose of bloodstream (particularly such as hypoglycemia /too low blood glucose). Aneurysm (a kind of structural defect that occurs in the brain). Problems that damage to the brain such as an injury of head, brain tumor, brain surgery, and stroke. In addition – an extremely fiver (especially if it occurs rapidly) and withdrawals of illegal drugs, certain prescription medications, or even abusing alcohol may also trigger and cause seizure. Can hyperglycemia or high blood sugar cause seizures? It is clear that hypoglycemia or too low blood sugar can be Continue reading >>
Diabetic Seizures In Dogs
Seeing your dog have a seizure can be pretty scary, especially the first time this happens. If the seizure is caused by diabetes complications, the good news is that future seizures can be prevented by controlling the dog's diabetes. Why Seizures Happen Any seizure—in a dog or a human—is caused by a kind of electrical storm in the brain. If a dog has diabetes, her body doesn't produce the right amount of insulin for control of blood sugar levels. Insulin is produced by the pancreas, and diabetes can be caused by too much or too little. Very low blood sugar levels can interrupt the normal functioning of the brain, leading to a diabetic seizure. Hypoglycemia and Hyperglycemia Problems relating to diabetes in dogs usually stem from a state of either hypoglycemia or hyperglycemia. A hypoglycemic dog has very low blood sugar and may experience a seizure as a result. In diabetic dogs, hypoglycemia commonly occurs when an insulin dose is given without sufficient food for the dog's body to utilize the insulin properly. The opposite diabetic state, hyperglycemia, occurs when the dog's blood sugar levels are extremely high. Although hyperglycemia does not typically cause seizures, this is a serious state in which the dog may become depressed, weak and anorexic. Hyperglycemia can cause a dog to become comatose. Seizure Prevention If your dog is diabetic, seizure prevention primarily involves preventing a state of hypoglycemia. Use insulin that is formulated specifically for dogs—Novolin, Vetsulin and Caninsulin are some of the most commonly used forms of canine insulin. Monitor your dog's blood glucose regularly to make sure the insulin dosage is correct and having the desired effect. Monitor your dog's feeding and exercise patterns, if possible with a regular daily schedule Continue reading >>
Hyperglycemia (high Blood Sugar)
Hyperglycemia is a hallmark sign of diabetes (both type 1 diabetes and type 2 diabetes) and prediabetes. Other conditions that can cause hyperglycemia are pancreatitis, Cushing's syndrome, unusual hormone-secreting tumors, pancreatic cancer, certain medications, and severe illnesses. The main symptoms of hyperglycemia are increased thirst and a frequent need to urinate. Severely elevated glucose levels can result in a medical emergency like diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS, also referred to as hyperglycemic hyperosmolar state). Insulin is the treatment of choice for people with type 1 diabetes and for life-threatening increases in glucose levels. People with type 2 diabetes may be managed with a combination of different oral and injectable medications. Hyperglycemia due to medical conditions other than diabetes is generally treated by treating the underlying condition responsible for the elevated glucose. Blood Sugar Swings: Tips for Managing Diabetes & Glucose Levels A number of medical conditions can cause hyperglycemia, but the most common by far is diabetes mellitus. Diabetes affects over 8% of the total U.S. population. In diabetes, blood glucose levels rise either because there is an insufficient amount of insulin in the body or the body cannot use insulin well. Normally, the pancreas releases insulin after a meal so that the cells of the body can utilize glucose for fuel. This keeps blood glucose levels in the normal range. Type 1 diabetes is responsible for about 5% of all cases of diabetes and results from damage to the insulin-secreting cells of the pancreas. Type 2 diabetes is far more common and is related to the body's inability to effectively use insulin. In addition to type 1 and type 2, gestational diabe Continue reading >>
This information is not meant to be a substitute for veterinary care. Always follow the instructions provided by your veterinarian. A seizure is defined as a paroxysmal, transitory disturbance of brain function that has a sudden onset, ceases spontaneously, and has a tendency to recur. Generalized seizures affect the entire body. Most commonly, animals will fall to the side, make paddling movements with the limbs; they will often will urinate, salivate and defecate during the episodes. Generalized seizures usually last from several seconds to upwards of a couple minutes. Focal seizures remain localized to one body region and are usually shorter in duration, lasting a couple seconds. Seizures may start focal and then become generalized. After the veterinarian is convinced that a seizure disorder is present, the most important question to be answered is whether the seizure is the result of primary brain disease (intracranial disease), or the result of a disturbance outside the brain (extracranial disease), The most common intracranial causes of seizures include: structural disease including hydrocephalus, head trauma, inflammatory brain disease (encephalitis), strokes and neoplasia (brain cancer). The most common causes of extracranial diseases that cause secondary brain signs include: toxins and metabolic diseases. Metabolic diseases include: low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), liver disease, kidney disease, electrolyte disturbances, toxins (poisons), anemia. Idiopathic epilepsy Idiopathic epilepsy is another common cause of seizures in dogs and less commonly in cats. It is by definition, seizures of unknown cause. These episodes are thought to be due to "mal-wiring" within the brain. Idiopathic epilepsy is seen in dogs between the ages of 6 Continue reading >>
Diabetic Seizures – What Are They? Symptoms, Causes, And Treatments
A diabetic seizure is a serious medical condition and without emergency treatment, it has proven to be fatal. Extremely low levels of sugar in the diabetic’s blood cause these seizures. That is why it is so important for those who have diabetes to monitor and control their blood sugar. What Are the Causes? A number of different things can actually cause a diabetic seizure to occur. It could happen because too much insulin is injected, or because the diabetic did not eat right after taking insulin. Some of the other potential causes include not eating meals regularly or drinking too much alcohol. Even certain oral diabetes medications can make the body produce excess insulin. Those who are exercising too much without taking into account how this will affect their insulin levels will also be at a greater risk of suffering a diabetic stroke. No matter what causes the seizure, it is always a medical emergency and those who have one need immediate medical attention. What Are the Symptoms? When entering the first stages of a diabetic seizure, the person may exhibit a number of different symptoms. Some of the most common symptoms include: Sweating Clamminess Drowsiness Confusion Bodily shakes Hallucinations Rapid and unexpected emotional changes Weakness in the muscles Anxiety Vision changes Loss of ability to speak clearly After these initial symptoms, the next phase of symptoms begin and the danger level rises. Now, the person may stare into space and be non-communicative and uncontrollable body movements and contractions of the muscles may occur. In some cases, the diabetic will be unaware of the movements and may even fall into unconsciousness. What Is the Prevention and Treatment? The best way to deal with this problem is by ensuring it does not occur in the first place Continue reading >>
Does Diabetes Cause Seizures?
Diabetes is a chronic condition in which insulin, the hormone that modulates the metabolism of sugar in the body, is either completely absent or ineffective in its function. Patients with diabetes usually present with abnormally high levels of glucose, or sugar, in their blood stream. With treatment, sugar levels are normalized, but can sometimes drop too low. Both high and low blood sugar can cause seizures in diabetic patients. Hyperglycemic seizures Hyperglycemia is the condition in which blood sugar is at abnormally high levels. High blood sugar leads to hyper-excitability of the neurons that make up the central nervous system, including the brain. Neurons need a normal level of glucose, their main source of energy, to function correctly. With the brain's overexcited imbalance, hyperglycemic seizures can be be triggered. In other words, too much sugar makes the neurons work too much, predisposing them to “short circuit,” causing a seizure. Hypoglycemic seizures Low blood sugar can also lead to seizures. Hypoglycemic seizures are actually more common than hyperglycemic seizures. The reason seems to be related to the fact the brain depends completely on body’s sugar to work, since it doesn’t produce its own glucose. It is difficult to predict at what level of glucose a patient will have a seizure, as patients with chronic high levels of glucose may have seizures at a higher level than does who have normal blood sugar. Low blood sugar reduces the activity of neurons in the brain. In the absence of this regulated function, the neurons respond by reducing the activity across synapses, the microscopic spaces in between neurons that propagate the brain’s activities and preserve bodily function. This in turn leads to a seizure. Other electrolyte imbalances Poorly Continue reading >>
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Journal Of The American Podiatric Medical Association
Focal epileptic seizures can be the first manifestation of a diabetic disorder. Metabolic disturbances, including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of partial focal seizures. A review of the medical literature for partial focal seizures is presented, followed by a case study of a patient who developed clonic seizures of the right foot secondary to hyperglycemia, hyponatremia, and hyperosmolality. (J Am Podiatr Med Assoc 92(2): 109-111, 2002) Continue reading >>
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Tonic Focal Seizures In Nonketotic Hyperglycemia Of Diabetes Mellitus
• Three patients had recurrent focal motor seizures as the first manifestation of nonketotic hyperglycemia (NKHG) of diabetes mellitus. The seizures were characterized by stereotypical tonic changes in body posture and arrest of speech that have been associated with supplementary motor area seizures. Recognition of the link between this unusual form of focal epilepsy and NKHG would help in the early diagnosis and treatment of the serious underlying metabolic disturbance. Continue reading >>
Nonketotic Hyperglycemia-related Epileptic Seizures
Abstract To investigate nonketotic hyperglycemia (NKH)-related epileptic clinical features and pathogenesis, and improve the diagnosis and treatment. Clinical data, including the clinical manifestations, laboratory tests, imaging studies and other information, of 13 patients with hyperglycemia-related epilepsy in our department were retrospectively analyzed. Blood glucose levels of the 13 patients when admitted to the hospital ranged between 24.7-34.6 mmol/L (average 28.3 mmol/L), their plasma osmolality ranged between 290–332 mOsm/L (average 308 mOsm/L), and their ketone results were negative. Among them, seven had convulsions, 4 had upper limbs and facial twitching, and 2 had bust twitch. Imaging findings could not detect accountable lesions related to seizures. EEG mainly showed spikes, slow waves, and scattered sharp slow waves. Insulin combined short-term antiepileptic drugs, allowed the epilepsy to be effectively controlled without recurrence. Patients with episodes of NKH epilepsy increased significantly with hyperglycemia. Raising awareness of the disease, early diagnosis, and very early lowering the hyperglycemia levels, can effectively control the seizures. Lowering blood glucose is an effective way to control blood glucose levels. Material and methods This research has been approved by the ethics committee of the Second Hospital affiliated to Nantong University. Informed consent has been obtained and this investigation has been conducted according to the principles expressed in the Declaration of Helsinki. Thirteen cases of NKH-related epileptic seizures were treated from December 2009 to October 2014 in our neurosurgery department. Among them, 8 were males, and 5 females, aged 45–80 years old (mean age: 54 ± 2 years old). Their diabetes duration was bet Continue reading >>
Case Report Nonketotic Hyperglycemia-related Epileptic Seizures
1. Introduction Seizures related to head trauma are often encountered in clinical practice, and some of them combine with nonketotic hyperglycemia (NKH) and variable hyperosmolarity. However, seizures related to nonketotic hyperglycemia (NKH) are rare in clinical practice. Because epileptic seizures related to NKH significantly affect neurological outcomes  and may cause misdiagnosis or missed diagnosis, more attention should be paid to them. In this manuscript, we report a case of NKH-related seizures. 2. Case presentation A 49-year-old male patient, without a known history of diabetes, was hospitalized because of a head trauma. Cranial CT scan showed mild subarachnoid hemorrhage without definite significance. On admission, his glucose and serum electrolyte levels were normal. Three days later, he developed partial seizures that began in his face. The average duration of the seizures in each episode was 4 min (range: 1–5 min, with one seizure lasting for 10 min) and could not be controlled by antiepileptic drugs. At the same time, his average plasma glucose level was 18.32 mmol/L (range: 15–24 mmol/L, normal range: 3.9–6.1 mmol/L), and his serum electrolyte levels were normal. When the seizures stopped, his average plasma glucose level decreased to 8.3 mmol/L (range: 4.7–11.2 mmol/L, normal range: 3.9–6.1 mmol/L). He had no family history of epilepsy and denied a history of spontaneous seizures or hyperglycemia. Under the guidance of an endocrinologist, the patient's hyperglycemia was treated with intravenous fluids and insulin and the seizures resolved. He was discharged 10 days later. He remained seizure- and antiepileptic drug-free after discharge as of his 3-month follow-up. 3. Discussion Focal seizures induced by hyperglycemia were first reported in 1 Continue reading >>
Magnetic Resonance Imaging Features In Seizures Associated With Nonketotic Hyperglycemia
1 Department of Neurology, China-Japan Union Hospital, Jilin Univetsity, Changchun, China 2 Department of Radiology, China-Japan Union Hospital, Jilin Univetsity, Changchun, China 3 Department of Thoracic Surgery, China-Japan Union Hospital, Jilin Univetsity, Changchun, China Date of Submission 29-May-2013 Date of Decision 11-Jun-2013 Date of Acceptance 09-Oct-2013 Date of Web Publication 22-Nov-2013 Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.121937 Sir, A 57-year-old female was admitted for episodic clonic jerks affecting her right face and arm, each episode lasting for approximately 2′ of 10 days duration. There was no improvement of jerks with carbamazepine, instead there was increase in the frequency (every 5′) and also developed right upper limb weakness. Past medical history was negative. Neurological examination revealed right hemiparesia. Admission serum glucose was 29.8 mmol/L with no ketone bodies in the urine; serum sodium was 133.8 mmol/L and potassium was 3.5 mmol/L; blood urea nitrogen was 6.0 mmol/L and calculated serum osmolality was 310.4 mmol/L. Admission computed tomography was normal. Electroencephalography (EEG) revealed inter-ictal epileptiform discharges around the left central sulcus [Figure 1]a-c. Brain magnetic resonance imaging (MRI) [Figure 2] done on day 2 of admission showed subcortical hypointensity signal changes in the left parietal region on T2-weighted (T2-W), fluid attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI). Apparent diffusion coefficient (ADC) map showed isointensity in the corresponding region. Overlying cortical showed hyperintensity on FLAIR, DWI sequences and hypointensity on ADC map. The ADC values in cortical and subcortical lesions were lower than contralatera Continue reading >>