Epilepsy in children with type 1 diabetes mellitus: Pathophysiological basis and clinical hallmarks. (March 2019)

• Record Type: Journal Article
• Authors: Mastrangelo, Mario; Tromba, Valeria; Silvestri, Francesca; Costantino, Francesco
• Is Part Of: European journal of paediatric neurology. Volume 23:Number 2(2019:Mar.)
• Page Start: 240
• Page End: 247
• Publication Date: 2019-03
• Subjects: Type 1 diabetes mellitus -- Epilepsy -- Metabolic disorders -- Autoimmune disorders -- Comorbidity; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2018.12.006
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: We provide an overview on the current knowledge about the association between epilepsy and type 1 diabetes mellitus (T1DM). People with T1DM have a 2–6-fold higher risk of epilepsy than the general population. The onset of T1DM anticipates the onset of epilepsy by a mean period between 1, 5 and 2, 8 years. These two disorders share four potential distinct pathogenic factors: a) genetic predisposition; b) factors involved in autoimmune responses (i.e. anti-glutamic acid decarboxylase antibodies-GADAbs); c) effects of hypo/hyperglycaemia; d) cerebrovascular damages resulting in ischaemic processes. Seizures semiology prominently includes focal (up to patterns of epilepsia partialis continua) or secondarily generalized seizures but also reflex seizures and various forms of generalized seizures. EEG abnormalities are more common in people with an inappropriate metabolic control with a prominent involvement of fronto-temporal regions. Epilepsy management does not differ between patients with and without diabetes and insulin, nutritional recommendations and physical activity may also produce significant benefits on seizures control. Possible therapeutic alternatives in selected cases include immunosuppressive drugs (in patients with GADAbs) and ketogenic diet.