Crises parciais motoras induzidas por movimentos em pacientes diabéticos

Tedrus, Glória M. A. S.; Albertin, Maria Cristina; Odashima, Newton S.; Fonseca, Lineu C.

doi:10.1590/S0004-282X1991000400013

Resumos

Levando em conta o número restrito de casos em âmbito internacional e a ausência de publicações na literatura nacional, os autores apresentam três casos de crises motoras focais induzidas por movimentos em pacientes diabéticos com mais de 50 anos de idade. As crises eram numerosas, sendo também desencadeadas ao serem assumidas determinadas posturas. Em dois casos havia hiperglicemia não cetótica. Todos os pacientes apresentavam hemiparesia e, em dois, tal déficit desapareceu após o cotnrole das crises. No outro paciente a hemiparesia era decorrente de acidente vascular cerebral isquêmico instalado 6 meses antes. Síndrome parietal transitória foi observada nos três pacientes. O EEG crítico mostrou, em dois pacientes, descargas na região parieto-occipital e, em um, na região temporal média contralateral. As crises foram resistentes aos anticonvulsivantes, só havendo controle com o tratamento dos distúrbios metabólicos. São discutidos aspectos clínico-eletren-cefalográficos e etiopatogênicos. A pesquisa do caráter reflexo das crises e a dosagem da glicemia devem ser feitas em todos os pacientes idosos com crises motoras focais, face às implicações de ordem terapêutica e prognóstica.

Three elderly patients with partial motor seizures triggered by movement or posture of an extremity are presented. They had a history of diabetes mellitus. Two of them had nonketotic hyperglycemia. Hemiparesis was present in the three patients, which resolved in two. In the other patient, hemiparesis resulted from a previous stroke. All patients had transitory parietal syndrome. During seizures, BEG showed discharges in the parieto-occipital area in two cases and in the mid-temporal area in one. Seizures were resistant to conventional anticonvulsivante therapy, and ceased only after treatment of metabolic disturbances. A search for reflex seizures and hyperglycemia should be carried out routinely in the elderly with repeated spontaneous focal motor seizures. This may be important for treatment and prognosis.

CONTENTS CONTEÚDO

Glória M. A. S. Tedrus^I; Maria Cristina Albertin^II; Newton S. Odashima^I; Lineu C. Fonseca^III

^IProfessor Assistente - Departamento de Neuropsiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP)

^IINeurologista do Hospital e Maternidade Celso Pierro, PUCCAMP - Departamento de Neuropsiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP)

^IIIProfessor Titular - Departamento de Neuropsiquiatria da Faculdade de Ciências Médicas da Pontifícia Universidade Católica de Campinas (PUCCAMP)

RESUMO

Levando em conta o número restrito de casos em âmbito internacional e a ausência de publicações na literatura nacional, os autores apresentam três casos de crises motoras focais induzidas por movimentos em pacientes diabéticos com mais de 50 anos de idade. As crises eram numerosas, sendo também desencadeadas ao serem assumidas determinadas posturas. Em dois casos havia hiperglicemia não cetótica. Todos os pacientes apresentavam hemiparesia e, em dois, tal déficit desapareceu após o cotnrole das crises. No outro paciente a hemiparesia era decorrente de acidente vascular cerebral isquêmico instalado 6 meses antes. Síndrome parietal transitória foi observada nos três pacientes. O EEG crítico mostrou, em dois pacientes, descargas na região parieto-occipital e, em um, na região temporal média contralateral. As crises foram resistentes aos anticonvulsivantes, só havendo controle com o tratamento dos distúrbios metabólicos. São discutidos aspectos clínico-eletren-cefalográficos e etiopatogênicos. A pesquisa do caráter reflexo das crises e a dosagem da glicemia devem ser feitas em todos os pacientes idosos com crises motoras focais, face às implicações de ordem terapêutica e prognóstica.

SUMMARY

Three elderly patients with partial motor seizures triggered by movement or posture of an extremity are presented. They had a history of diabetes mellitus. Two of them had nonketotic hyperglycemia. Hemiparesis was present in the three patients, which resolved in two. In the other patient, hemiparesis resulted from a previous stroke. All patients had transitory parietal syndrome. During seizures, BEG showed discharges in the parieto-occipital area in two cases and in the mid-temporal area in one. Seizures were resistant to conventional anticonvulsivante therapy, and ceased only after treatment of metabolic disturbances. A search for reflex seizures and hyperglycemia should be carried out routinely in the elderly with repeated spontaneous focal motor seizures. This may be important for treatment and prognosis.

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Full text available only in PDF format.

Dr. Lineu Corrêa Fonseca - Departamento de Neuropsiquiatria, Faculdade de Ciências Médicas, PUCCAMP - Av. John Boyd Dunlop s/nº - 13060 Campimas SP - Brasil.

1. Aquino A, Babos AJ. Movement-induced seizures in nonketotic hyperglycemia. Neurology 1980, 30:600-604.
2. Askenasy JH, Strieifler M, Carasso R. Moderate nonketotic hyperglycemia: a cause of focal epilepsy. Eur Neurol 1977, 16:51-61.
3. Brick JF, Gutrecht JA, Ringel RA. Reflex epilepsy and nonketotic hyperglycemia in the elderly: a specific neuroendrocrine syndrome. Neurology 1984, 39:394-399.
4. Buscaino GA, Striano S, Meo R, Bilo L. Reflex epilepsy: a proposal for classification and pathogenetic suggestions. Acta Neurol Scand 1985, 37:207-218.
5. Daniels Jd. Chokroverty S, Barron KO. Anacidotic hyperglycemia and focal seizures. Arch Intern Med 1969, 124:701-706.
6. Falconer MA. Driver MV, Serafenitides EA. Seizures induced by movement: report of a case relieved by operation. J Neurol Neurosurg Phychiat 1963, 26:300-307.
7. Gabor AC. Focal seizures induced by movement without sensory feedback mechanisms. Electroenceph Clin Neurophysiol 1974, 36:403-408.
8. Kertesz A. Paroxysmal kinesigenic choreaothetosis. Neurology 1967, 17:680-690.
9. Lishman WA, Symonds CP, Whitty. Seizures induced by movement. Brain 1962, 85:93-108.
10. Maccario M, Brooblyn NY. Neurological dysfunction associated with nonketotic hyperglycemia. Arch Neurol 1968, 19:535-531.
11. Maccario M. Messis CP. Vastola EF. Focal seizures as a manifestation of hyperglycemia without ketoacidosis. Neurology 1965, 15:195-206.
12. Perez-Borja C. Tassinari AC. Swanson AG. Paroxysmal choreoathetosis and seizures induced by movement (reflex epilepsy). Epilepsy 1967, 8:260-270.
13. Pitha V - Epilepsie reflexe. Rev Neurol 1938. 70:178-181.
14. Singh BM, Gupta D. Strobos RJ. Nonketotic hyperglycemia and epilepsia partialis continua. Arch Neurol 1973. 29:187-190.
15. Sing BM, Strobos RJ. Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients. Ann Neurol 1980, 8:155-160.
16. Vastola EF. Maccaro M. Homan R. Activation of epileptogenic foci by hyperosmolality. Neurology 1967. 17:520-526.
17. Venna N. Sabin TD. Tonic focal seizures in nonketotic hyperglycemia of diabetes mel-litus. Arch Neurol 1981, 38:512-514.
18. Whitty CWM. Lishman WA. Fitz Gibbison JP. Seizures induced by movement: a form of reflex epilepsy. Lancet 1964, 1:1403-1406.

Crises parciais motoras induzidas por movimentos em pacientes diabéticos

Movement-induced seizures and diabetes mellitus

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Dez 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aquino A, Babos AJ. Movement-induced seizures in nonketotic hyperglycemia. Neurology 1980, 30:600-604.

[2] 2. Askenasy JH, Strieifler M, Carasso R. Moderate nonketotic hyperglycemia: a cause of focal epilepsy. Eur Neurol 1977, 16:51-61.

[3] 3. Brick JF, Gutrecht JA, Ringel RA. Reflex epilepsy and nonketotic hyperglycemia in the elderly: a specific neuroendrocrine syndrome. Neurology 1984, 39:394-399.

[4] 4. Buscaino GA, Striano S, Meo R, Bilo L. Reflex epilepsy: a proposal for classification and pathogenetic suggestions. Acta Neurol Scand 1985, 37:207-218.

[5] 5. Daniels Jd. Chokroverty S, Barron KO. Anacidotic hyperglycemia and focal seizures. Arch Intern Med 1969, 124:701-706.

[6] 6. Falconer MA. Driver MV, Serafenitides EA. Seizures induced by movement: report of a case relieved by operation. J Neurol Neurosurg Phychiat 1963, 26:300-307.

[7] 7. Gabor AC. Focal seizures induced by movement without sensory feedback mechanisms. Electroenceph Clin Neurophysiol 1974, 36:403-408.

[8] 8. Kertesz A. Paroxysmal kinesigenic choreaothetosis. Neurology 1967, 17:680-690.

[9] 9. Lishman WA, Symonds CP, Whitty. Seizures induced by movement. Brain 1962, 85:93-108.

[10] 10. Maccario M, Brooblyn NY. Neurological dysfunction associated with nonketotic hyperglycemia. Arch Neurol 1968, 19:535-531.

[11] 11. Maccario M. Messis CP. Vastola EF. Focal seizures as a manifestation of hyperglycemia without ketoacidosis. Neurology 1965, 15:195-206.

[12] 12. Perez-Borja C. Tassinari AC. Swanson AG. Paroxysmal choreoathetosis and seizures induced by movement (reflex epilepsy). Epilepsy 1967, 8:260-270.

[13] 13. Pitha V - Epilepsie reflexe. Rev Neurol 1938. 70:178-181.

[14] 14. Singh BM, Gupta D. Strobos RJ. Nonketotic hyperglycemia and epilepsia partialis continua. Arch Neurol 1973. 29:187-190.

[15] 15. Sing BM, Strobos RJ. Epilepsia partialis continua associated with nonketotic hyperglycemia: clinical and biochemical profile of 21 patients. Ann Neurol 1980, 8:155-160.

[16] 16. Vastola EF. Maccaro M. Homan R. Activation of epileptogenic foci by hyperosmolality. Neurology 1967. 17:520-526.

[17] 17. Venna N. Sabin TD. Tonic focal seizures in nonketotic hyperglycemia of diabetes mel-litus. Arch Neurol 1981, 38:512-514.

[18] 18. Whitty CWM. Lishman WA. Fitz Gibbison JP. Seizures induced by movement: a form of reflex epilepsy. Lancet 1964, 1:1403-1406.