Epileptic seizure as the first sign of hypoparathyroidism

Abstract

Background. Hypoparathyroidism refers to a group of disorders in which extracellular calcium levels cannot be maintained within the normal range due to relative or absolute deficiency of parathyroid hormone (PTH). The clinical features of hypoparathyroidism are consistent with hypocalcaemia and, predominantly, neuromuscular dysfunction. Although hypocalcaemia-induced seizures are well documented hypoparathyroidism-induced epilepsy is often misdiagnosed as idiopathic epilepsy. Case report. We reported a 57-year-old woman with new-onset seizure due to hypoparathyroidism. At first, diagnosis of epilepsy was established and the antiepileptic therapy was initiated with gradual increase of the dose. Computerized tomography scan of the head revealed bilateral basal ganglia and cerebellar calcification and many punctiform calcifications between cortical and subcortical parts. During hospitalization, laboratory tests showed hypocalcemia, hyperphosphatemia and low PTH level. Once the diagnosis of hypoparathyroidism was established, a proper treatment with calcium and vitamin D was started, and the patient was discharged from hospital with full seizure control. Conclusion. Standard evaluation of serum calcium levels in patients with new-onset epileptic seizures should be obligatory part of a diagnostic algoritam to avoid misdiagnosis of idiopathic epilepsy.Uvod. Hipoparatireoidizam obuhvata grupu poremecaja u kojima se zbog relativnog ili apsolutnog nedostatka paratireoidnog hormona (PTH) ne moze odrzati normalna koncentracija ekstracelularnog kalcijuma. Klinicku prezentaciju hipoparatireoidizma u najvecoj meri kreira hipokalcemija sa pratecim neuromuskularnim disfunkcijama. Iako postoje brojni podaci o epilepticnom praznjenju uzrokovanom hipokalcemijom, epilepsija kao posledica hipoparatireoidizma cesto se pogresno dijagnostikuje kao idiopatska. Prikaz bolesnika. Prikazali smo bolesnicu staru 57 godina, sa prvom epizodom epilepticnog napada. Postavljena je dijagnoza epilepsije i otpoceta antiepilepticna terapija sa postepenim povecanjem doze. Kompjuterizovana tomografija glave otkrila je kalcifikacije bazalnih ganglija, cerebeluma i brojne punktiformne kalcifikacije izmedju korteksa i supkorteksa. U narednom periodu, laboratorijske analize pokazale su hipokalcemiju, hiperfosfatemiju i nizak PTH. Dijagnostikovani hipoparatireoidizam i primenjena terapija kalcijumom i vitaminom D, uz antiepileptike, doveli su do normalizacije elektroencefalograma (EEG) i potpune kontrole epilepsije. Zakljucak. Rutinska evaluacija serumskog jonizovanog kalcijuma trebalo bi da bude sastavni deo dijagnostickog algoritma kod bolesnika sa prvom epizodom epilepticnog napada.