Abstract Details

Title Epilepsia Partialis Continua Secondary to Diabetic Ketoacidosis

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-029

Objective Epilepsia partialis continua (EPC) is a rare focal motor subtype of status epilepticus typically secondary to structural lesions of the central nervous system but also with metabolic causes.

Background A 68 year old female with a history of type 2 diabetes mellitus presented to the emergency department with one week of involuntary, recurrent episodes of left upper extremity jerking. These episodes had been occurring every 3 to 5 minutes and consisted of repetitive, clonic movements of the left wrist, elbow, and fingers of the left hand. They would last 10 to 45 seconds with occasional involvement of left facial muscles. There was no loss of consciousness or alteration of awareness. Labs demonstrated a serum glucose of 432, anion gap of 26, and large amount of serum and urine ketones. Video EEG captured six episodes with corresponding rhythmic, low amplitude spikes in the right central head region. Contrasted MR imaging of the brain was negative for significant structural lesions and CSF studies were unremarkable. After appropriate glucose control and initiation of lacosamide and levetiracetam, the patient continued to have focal motor seizures which gradually resolved over the next several days

Design/Methods Not Applicable

Results Not Applicable

Conclusions EPC has been described to occur in up to 25% of patients with non-ketotic hyperglycemia (NKH), but to date there has only been one case report describing a ketotic hyperglycemia patient with EPC. Seizures are considered rare in diabetic ketoacidosis. Furthermore, our patient did not have a structural lesion as most patients with EPC secondary to hyperglycemic crisis are found to have. Our case also demonstrates that EPC secondary to hyperglycemic crisis may be refractory to multiple anti-convulsants and persist for days without secondary generalization, even after correction of the hyperglycemia. Therefore, less aggressive use of anti-convulsants may be warranted for these patients.

Authors/Disclosures
Jacob L. Van Orman, MD (David Grant Medical Center - US Air Force) PRESENTER	Dr. Van Orman has nothing to disclose.
Tyler Koehn, MD	Dr. Koehn has nothing to disclose.
Thomas Duginski, MD	No disclosure on file

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