Successfully Treating Convulsions Beyond Anticonvulsant Therapy
Nov 11 2022 |
Medicover Hospitals |
An 11-month-old female baby presented with recurrent afebrile convulsions since 9 months of age. Clinical history revealed that the patient born to a non- consanguineous couple was undergoing treatment for the same at an outside hospital and was on anticonvulsant treatment for 2 months without being investigated for the cause. Despite undergoing treatment with anticonvulsants, the patient suffered from recurrent episodes of convulsions. On examination, the development of the baby was found to be normal, with no dysmorphic features, nor systemic disturbances found.
Convulsions are a condition in which the muscles contract and relax quickly, which causes uncontrolled shaking of the body that lasts for a few seconds to minutes. Convulsions are caused due to head injury, genetic defects, infections like meningitis, and certain drugs that cause convulsions. Congenital hyperinsulinism is caused by genetic mutations that result in inappropriate and excess insulin secretions from the beta cells of the pancreas that cause low plasma sugar(hypoglycemia) or low blood sugar. We present our case report on treating convulsions beyond anticonvulsant therapy.
Case Report:
The patient was admitted for a complaint of recurrent afebrile convulsions and appropriate investigations were advised. Blood investigations showed decreased blood sugar and high levels of serum ammonia with other parameters being within normal limits. Radiological investigations (CT brain) showed no abnormalities. A hormonal study of serum showed increased levels of insulin and elevated C-peptide levels.
Based on the reports, the patient was diagnosed to be suffering from congenital hyperinsulinism (hyperam-monemia and hyperins-ulinism). The patient was hence admitted for management of congenital hyperinsulinism (hyperammonemia and hyperinsulinism). The course of treatment followed included frequent glucose feeds and diazoxide administration. The entire course of treatment for 5 days was uneventful. On review, the growth of the baby was found to be good with no further episodes of convulsions post-discharge.
Discussion
The use of anticonvulsants without investigating the cause of convulsions shows no results. The cause of it should be investigated and treated accordingly. Analyzing the cause of convulsions both hypoglycemia and estimating the blood sugar levels, plays a significant role in planning the care appropriately. The first line of intervention in such cases of hyperinsulinism-induced convulsions includes treatment with frequent glucose feeds and drugs, such as diazoxide, somatostatin analogs, and nifedipine.
Hyperinsulinism with hyperplasia of the pancreas showing no response to drugs/medical management should be further investigated with investigations like PET dopa scan to know the extent of pancreatic involvement and choose a treatment pathway accordingly. Hyperinsulinism with hyperplasia of the pancreas showing no response to drugs will require surgical intervention, such as partial/full pancreatectomy depending on the involvement of the pancreas.
