Epilepsia partialis continua associated with ketotic hyperglycemia and tuberculous meningoencephalitis: A case report

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Abstract

We report the case of an 18‐year‐old girl who presented with several episodes of simple partial motor seizures compatible with the diagnosis of epilepsia partialis continua. In addition to ketotic hyperglycemia, tuberculous meningoencephalitis was diagnosed based on clinical, biological, and brain imaging findings. The seizures ceased after normalization of glycemia.

Abstract

Epilepsia partialis continua (EPC) is a rare form of focal status epilepticus. Non‐ketotic hyperglycemia is a frequent cause of EPC. Antiepileptic drugs are usually ineffective in treating hyperglycemia‐related EPCs. It is crucial to search for potential coexisting underlying causes and initiate an appropriate etiological treatment to control seizures.

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Tuberculous Meningitis: Diagnosis and Treatment Overview

Grace Marx, Edward D Chan (2011)

Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis (TB) and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF) findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher rates of drug-resistant TB. Testing the efficacy of second-line and new anti-TB drugs in animal models of experimental TBM is needed to help determine the optimal regimen for drug-resistant TB.

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The social epidemiology of tuberculosis in South Africa: a multilevel analysis.

Guy Harling, Rodney Ehrlich, Landon Myer (2007)

Increased risk of tuberculosis is widely recognized to be associated with increased poverty, yet there have been few analyses of the social determinants of tuberculosis, particularly in high-burden settings. We conducted a multilevel analysis of self-reported tuberculosis disease in a nationally representative sample of South Africans based on the 1998 Demographic and Health Survey (DHS). Individual and household-level demographic, behavioral and socioeconomic risk factors were taken from the DHS; data on community-level socioeconomic status (including measures of absolute wealth and income inequality) were derived from the 1996 national census. Of the 13,043 DHS respondents, 0.5% reported having been diagnosed with tuberculosis disease in the past 12 months and 2.8% reported having been diagnosed with tuberculosis disease in their lifetime. In a multivariate model adjusting for demographic and behavioral risk factors, tuberculosis diagnosis was associated with cigarette smoking, alcohol consumption and low body mass index, as well as a lower level of personal education, unemployment and lower household wealth. In a model including individual- and household-level risk factors, high levels of community income inequality were independently associated with increased prevalence of tuberculosis (adjusted odds ratio for lifetime tuberculosis comparing the most unequal quintile to the middle quintile of inequality: 2.37, 95% confidence interval: 1.59-3.53). These results provide novel insights into the socioeconomic determinants of tuberculosis in developing country settings, although the mechanisms through which income inequality may affect tuberculosis disease require further investigation.

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Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients.

B M Singh, R J Strobos (1980)

In 21 patients, epilepsia partialis continua (EPC) was an early symptom of nonketotic hyperglycemia and occurred during an initial phase of hyponatremia and mild hyperosmolality. EPC persisted for an average of 8 days, and its duration correlated predominantly with the degree of hyponatremia. Depression of consciousness and cessation of seizures occurred with increasing severity of hyperglycemia and hyperosmolality. In 9 patients, EPC was the first symptom leading to the diagnosis of diabetes mellitus. Four patients died of serious associated illness. The majority of the patients had evidence of a localized structural cerebral lesion. Metabolic disturbances including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of EPC in areas of focal cerebral damage.

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Author and article information

Contributors

Marius Baguma:

ORCID: https://orcid.org/0000-0002-4934-4846

baguma.akonkwa@ucbukavu.ac.cd

Journal

Journal ID (nlm-ta): Clin Case Rep

Journal ID (iso-abbrev): Clin Case Rep

Journal ID (doi): 10.1002/(ISSN)2050-0904

Journal ID (publisher-id): CCR3

Title: Clinical Case Reports

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2050-0904

Publication date (Electronic): 15 February 2022

Publication date Collection: February 2022

Volume: 10

Issue: 2 ( doiID: 10.1002/ccr3.v10.2 )

Electronic Location Identifier: e05460

Affiliations

[ ¹ ] ringgold 482228; Neurology Ward Department of Internal Medicine Hôpital Provincial Général de Référence de Bukavu (HPGRB) Bukavu Democratic Republic of the Congo

[ ² ] ringgold 482228; Radiology Ward Department of Internal Medicine Hôpital Provincial Général de Référence de Bukavu (HPGRB) Bukavu Democratic Republic of the Congo

[ ³ ] ringgold 482228; Diabetology and Endocrinology Ward Department of Internal Medicine Hôpital Provincial Général de Référence de Bukavu (HPGRB) Bukavu Democratic Republic of the Congo

[ ⁴ ] Faculty of Medicine Université Catholique de Bukavu (UCB) Bukavu Democratic Republic of the Congo

[ ⁵ ] Center for Tropical Diseases and Global Health (CTDGH) Université Catholique de Bukavu (UCB) Bukavu Democratic Republic of the Congo

Author notes

[*] [* ] Correspondence

Marius Baguma, Neurology Ward, Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Avenue Michombero 2, 285 Bukavu, Democratic Republic of the Congo.

Email: baguma.akonkwa@ 123456ucbukavu.ac.cd

Author information

Cordule Balola https://orcid.org/0000-0002-3927-5891

Fabrice Nzabara https://orcid.org/0000-0002-7575-7695

Christian Tshongo Muhindo https://orcid.org/0000-0002-9511-7994

Cirhuza Cikomola https://orcid.org/0000-0002-0856-5992

Ghislain Balemba Maheshe https://orcid.org/0000-0003-2227-5999

Marius Baguma https://orcid.org/0000-0002-4934-4846

Article

Publisher ID: CCR35460

DOI: 10.1002/ccr3.5460

PMC ID: 8847411

SO-VID: 35cd1399-6199-474e-beb9-bd3c8f036ef5

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date revision received : 29 January 2022

Date received : 28 December 2021

Date accepted : 06 February 2022

Page count

Figures: 1, Tables: 1, Pages: 5, Words: 3025

Custom metadata

source-schema-version-number 2.0

cover-date February 2022

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.1 mode:remove_FC converted:15.02.2022

Keywords: case report,cortical laminar necrosis,epilepsia partialis continua,hyperglycemia,ketosis,tuberculosis

Data availability:

Keywords: case report, cortical laminar necrosis, epilepsia partialis continua, hyperglycemia, ketosis, tuberculosis

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Epilepsia partialis continua associated with ketotic hyperglycemia and tuberculous meningoencephalitis: A case report

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Most cited references 13

Tuberculous Meningitis: Diagnosis and Treatment Overview

The social epidemiology of tuberculosis in South Africa: a multilevel analysis.

Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients.

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