Is it Epilepsy or Sugar Low Seizures?

by Theresa Garnero

Question. I am a 62 year old female that had my first seizure in 1997 when I was 54. I had the seizure after I went to sleep. Fifteen months later I had my second seizure. The MRI and CT showed nothing abnormal. They said I was epileptic. I was then prescribed Dilantin and have since had 2 more seizures, a year or so apart, all after I was asleep. A glucose tolerance test revealed my glucose level was 27!

A seizure is a disturbance in the electrical activity of the brain. If sugar is important to the function of the body, then I am assuming that severely low sugar can cause this disturbance in the electrical activity of the brain. The research about hypoglycemia always says you can have seizures if the sugar drops low. What kind of seizure do you have? My seizures were called tonic-clonic. But if my sugar dropped after I went to sleep, why couldn't I have had a sugar low seizure? At that time, I was not eating right, skipping meals, etc.

This epilepsy diagnosis has been bothering me and I would like to know if the sugar low seizures could be what had happened to me. I also wonder if by using Dilantin or other seizure disorder drugs, would camouflage the real reason of the seizure?

Answer. As a nurse, I can share some of the research findings related to diabetes and epilepsy. I am not a diagnostician, however, and I would suggest you see a specialist, like a neurologist (or a physician from the subspecialty of epileptologist) and/or endocrinologist regarding your particular situation. It is sometimes difficult to obtain a differential diagnosis as to the root of the seizures and certainly something I'm afraid I won't be able to resolve for you here. Let's review seizure-related basics for those who may not be familiar and address some of the concerns raised.

What is epilepsy? According to Mosby's Medical, Nursing, & Allied Health Dictionary, epilepsy is a recurrent episode of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or all of these. Common to all types of epilepsy is an uncontrolled electric discharge from the nerve cells of the cerebral cortex (a thin layer of gray matter which covers the surface of the brain) which causes the body to convulse or temporarily lose function. The frequency of attacks may range from many times a day to intervals of several years. Some seizures have a warning, like an aura, and others have none. They may be localized (focal motor) or involve the entire body (tonic-clonic).

What causes epilepsy? Oftentimes, the cause is unknown. It may be associated with cerebral trauma, intracranial infection, brain tumor, pancreatic tumor (which causes an increased insulin release and subsequent hypoglycemia), vascular disturbances, intoxication, or chemical imbalance. Seizures may occur at night (noctural seizures), or after physical stimulation, such as a flickering light or a loud sound. Emotional disturbances can trigger a seizure, as can hypoglycemia and hyperglycemia. People with the tendency to have seizures are more likely to have one triggered by fluctuations in blood glucose levels, but the reverse is not necessarily true. If a person is not prone to seizures, a swing in glucose levels typically would not cause a seizure. Persons with hyperglycemia tend to have focal or local seizures, whereas those who are hypoglycemic, tend to have tonic-clonic seizures, also called a hypoglycemic-induced seizure.

Did you know that seizures in persons using dietary supplements have been reported through the Food and Drug Administration? These supplements involved ephedra, herbal caffeine, creatine, St. John's wort, and ginkgo biloba (Haller, Meier, and Olson: 2005; Clinical Toxicology).

Is it epilepsy or diabetes-related hypoglycemia? Observation of the pattern and characteristics of the seizures, an electroencephalogram, (EEG) and CT scans, can aide in the diagnosis. Nocturnal epilepsy amplifies the difficulty of diagnosis because seizures that occur at night are less likely to be witnessed than daytime seizures.

Some case studies in the literature show patients who presented with a tonic-clonic seizure associated with hypoglycemia were mistakenly diagnosed with epilepsy. If you are taking a medication that causes the pancreas to release more insulin (like Glucotrol, Amaryl, Prandin, Glipizide, to name a few) or if you are taking insulin injections, it is imperative to discern whether you are having low glucose levels during the night while sleeping as this could be the cause of your seizures. A continuous glucose monitoring system, a pager-sized device typically worn for 2-3 days that continually measures glucose, can determine if you are going too low. Discuss this option with your doctor.

How is epilepsy treated? The physician determines the type of preventative, anti-seizure medication based on the type of seizure experienced. This is a source of frustration for many people who ask, "Why do I need to take this medicine if I am not having seizures?" Anti - seizure medication should be taken regularly for the same reason it is recommended to continue taking high blood pressure or diabetes medication even when the numbers are in the ideal range—to keep the medical condition under control! Plus, the risk of a second seizure within 3 years of having a first seizure is about 30% and the lifetime risk of recurrence is 14-50%. Other factors are important in the treatment of seizures: removing tumors (if that is the cause) and correcting metabolic disturbances.

For people with diabetes, controlling glucose levels is key to minimizing the effect diabetes has on the nervous system. Also, the effect of sleep quality on seizure frequency is well known in the literature. A careful scrutiny of potential sleep disturbing factors such as primarysleep disorders is of utmost importance to the successful management of seizures.

Whenever faced with a chronic health condition, like diabetes or epilepsy, it always helps to speak with the experts and those who experience it firsthand. Check with your hospital or healthcare provider about a local support group. At the Community Hospital of the Monterey Peninsula where I work, for example, we have a monthly epilepsy support group. I hope you can find a local group and/or impassioned professionals who can help.

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Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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