Focal clonic status epilepticus due to nonketotic hyperglycemia

This 78-year-old woman was treated with corticosteroids for severe asthma. She had no neurologic antecedents. She was admitted with focal right motor status epilepticus with serial seizures, a kinesigenic element and postictal Todd palsy. Ictal EEG showed sporadic left central spikes and slow waves. Emergency CT showed mild atrophy without any evidence of an acute lesion. Her family reported an increase in food and water intake and a 5-kg weight loss over the previous few weeks. Biochemical investigations revealed significant hyperglycemia (glucose levels above 30 mmol/L) without associated ketosis. Normalization of hyperglycemia with insulin led to the complete disappearance of seizures within 12 hours. No long-term anti-epileptic treatment was necessary. This case shows that a diffuse metabolic process can lead to focal status epilepticus. (Courtesy of Philippe Convers, CHU Saint-Etienne, France. Used with permission from: Panayiotopoulos CP, Benbadis SR, Sisodiya SM. Focal epilepsies: seizures and syndromes. Oxford: Medicinae, 2008a:1-256.)