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Journal of Zhejiang University SCIENCE B

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An insulinoma with clinical and electroencephalographic features resembling complex partial seizures

Abstract: We described a female patient with insulinoma who experienced recurrent episodes of automatism, confusion and convulsion. Furthermore, her electroencephalography (EEG) findings resembled the pattern in complex partial seizures with secondary generalization. The interictal EEG showed spikes and sharp waves, as well as focal slowing over the left temporal lobe, and the ictal EEG revealed generalized spikes and sharp waves associated with diffused slowing. She was initially misdiagnosed as pharmacoresistant epilepsy. After the insulinoma was found and surgically removed, her EEG turned normal and she was seizure-free during the 4-year follow-up. This report highlights the need for careful reassessment of all seizures refractory to medication, even for the patients associated with epileptiform discharges on EEG.

Key words: Insulinoma, Hypoglycemia, Electroencephalography (EEG), Seizure


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[1] Abdelmalik, P.A., Shannon, P., Yiu, A., Liang, P., Adamchik, Y., Weisspapir, M., Samoilova, M., Burnham, W.M., Carlen, P.L., 2007. Hypoglycemic seizures during transient hypoglycemia exacerbate hippocampal dysfunction. Neurobiol. Dis., 26(3):646-660.

[2] Akanji, A.O., George, A.O., Olasode, B.J., Osotimehin, B.O., 1992. Insulinoma in pregnancy presenting as a seizure disorder: a case report. East. Afr. Med. J., 69(2):117-119.

[3] Bazil, C.W., Pack, A., 2001. Insulinoma presenting as seizure disorder. Neurology, 56(6):817-818.

[4] Dizon, A.M., Kowalyk, S., Hoogwerf, B.J., 1999. Neuroglycopenic and other symptoms in patients with insulinomas. Am. J. Med., 106(3):307-310.

[5] Engel, R., Halberg, F., Tichy, F.Y., Dow, R., 1954. Electrocerebral activity and epileptic attacks at various blood sugar levels with a case report. J. Neural. Transm., 9(1-4):147-167.

[6] Gellhorn, E., Kessler, M., 1942. The effect of hypoglycemia on the electroencephalogram at varying degrees of oxygenation of the blood. Am. J. Physiol., 136:1-6.

[7] Graves, T.D., Gandhi, S., Smith, S.J., Sisodiya, S.M., Conway, G.S., 2004. Misdiagnosis of seizures: insulinoma presenting as adult-onset seizure disorder. J. Neurol. Neurosurg. Psychiatry, 75(8):1091-1092.

[8] Jaladyan, V., Darbinyan, V., 2007. Insulinoma misdiagnosed as juvenile myoclonic epilepsy. Eur. J. Pediatr., 166(5):485-487.

[9] Kirchner, A., Velísková, J., Velísek, L., 2006. Differential effects of low glucose concentrations on seizures and epileptiform activity in vivo and in vitro. Eur. J. Neurosci., 23(6):1512-1522.

[10] McLean, A.M., Fairclough, P.D., 2005. Endoscopic ultrasound in the localisation of pancreatic islet cell tumours. Best Pract. Res. Clin. Endocrinol. Metab., 19(2):177-193.

[11] Mitrakou, A., Fanelli, C., Veneman, T., Perriello, G., Calderone, S., Platanisiotis, D., Rambotti, A., Raptis, S., Brunetti, P., Cryer, P., et al., 1993. Reversibility of unawareness of hypoglycaemia in patients with insulinomas. N. Engl. J. Med., 329(12):834-839.

[12] Noone, T.C., Hosey, J., Firat, Z., Semelka, R.C., 2005. Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. Best Pract. Res. Clin. Endocrinol. Metab., 19(2):195-211.

[13] Ratcheson, R.A., Blank, A.C., Ferrendelli, J.A., 1981. Regionally selective metabolic effects of hypoglycemia in brain. J. Neurochem., 36(6):1952-1958.

[14] Service, F.J., McMahon, M.M., O'Brien, P.C., Ballard, D.J., 1991. Functioning insulinoma-incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo. Clin. Proc., 66(7):711-719.

[15] Sperling, M.R., 1984. Hypoglycemic activation of focal abnormalities in the EEG of patients considered for temporal lobectomy. Electroencephalogr. Clin. Neurophysiol., 58(6):506-512.

[16] Striano, S., Striano, P., Manganelli, F., Boccella, P., Bruno, R., Santoro, L., Percopo, V., 2003. Distal hypoglycemic neuropathy. An insulinoma-associated case, misdiagnosed as temporal lobe epilepsy. Neurophysiol. Clin., 33(5):223-227.

[17] Tan, N.C., Tan, A.K., Sitoh, Y.Y., Loh, K.C., Leow, M.K., Tjia, H.T., 2002. Paroxysmal exercise-induced dystonia associated with hypoglycaemia induced by an insulinoma. J. Neurol., 249(11):1615-1616.

[18] Tokizane, T., Sawyer, C.H., 1957. Sites of origin of hypoglycemic seizures in the rabbit. Arch. Neurol. Psychiatry, 77(3):259-266.

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DOI:

10.1631/jzus.B0720011

CLC number:

R736.7

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Received:

2007-12-20

Revision Accepted:

2008-03-02

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