Introduction: Epilepsy or seizures are often observed in patients with diabetes mellitus (DM). Different types of seizures occur in approximately 25% of patients with DM. The exact cause remains undetermined. Moreover, a possible association between T1DM and epilepsy exists. Risk factors for epilepsy in T1DM include younger age at onset, recurrent hypoglycemia or DKA, and poor glycemic control.
Aim of the work: The aim of this work was to detect the relationship between DM diagnosed before 2 years of age and epilepsy.
Methods and Patients: This study was an observational retrospective study conducted on 62 patients diagnosed with DM before 2 years of age attending the Pediatric Diabetes clinic in Alexandria University Children’s Hospital. Their mean age at onset was 11.21 ± 5.06 months, with almost 1:1 male to female ratio. Patients were divided into 3 groups according to age of onset: Group 1 (≤6 months), Group 2 (6-12 months), and Group 3 (>12-24 months). Detailed history taking and thorough clinical examination were done to all patients with emphasis on duration of diabetes, initial presentation (DKA or non-DKA), cerebral edema, convulsions at diagnosis, and history of hypoglycemia. In addition, laboratory investigations were performed such as blood glucose level, HbA1c at follow up, antiGAD-65 Ab levels, and all these parameters were compared in epileptic and non-epileptic diabetic patients. EEG was done to all patients, and brain imaging was done in patients with associated neurological manifestations.
Results: Nine patients (14.5%) diagnosed with DM before 2 years had associated epilepsy; which was commonly observed in patients aged 6-12 months at onset (66.7%). Six of these patients were on anticonvulsants. 77.8% of the patients with epilepsy had DKA at initial presentation, and most of them had severe forms. Eight patients (88.9%) had EEG findings. Generalized epileptiform activity was the most frequently encountered (62.5%). Five patients had T1DM (55.6%), 3 patients had monogenic DM (33.3%), and one patient had an unidentified cause of DM. No significant difference could be demonstrated between epileptic and non-epileptic patients as regards duration of DM, DKA, cerebral edema, hypoglycemic attacks, or glycemic control, while T1DM patients experiencing convulsions at diagnosis were more likely to have epilepsy (FEP=0.036*). There was no statistically significant relation between epilepsy in T1DM and antiGAD-65 Ab level.
Conclusions: DM diagnosed before 2 years of age can be associated with epilepsy, especially type 1 DM. However, risk factors causing this association still need to be further investigated.
15 Sep 2022 - 17 Sep 2022