Abstracts

RATIONALE: The sensitivity of the developing nervous system to hypoglycemia has been well established in recent years. Epilepsy syndromes may result from early brain injury caused by trauma or by hypoxia, but a specific syndrome caused by neonatal hypoglycemia has not been described.
METHODS: Four children who had hypoglycemia in the neonatal period and developed epilepsy during the first two years of life were identified. The interictal and ictal EEG recordings, neuroimaging studies, neurological examinations, history, and developmental assessments of these subjects were reviewed.
RESULTS: A distinct pattern of abnormalities on the neuroimaging was observed in these subjects. Their patterns of clinical seizures and EEG abnormalities were also similar. Three out of four patients showed bilateral occipital lobe atrophic changes on MRI scanning. The remaining patient had unilateral occipital lobe atrophy. All four children had markedly abnormal interictal EEG studies with occipital spikes in two cases and more generalized spike and wave discharges in two cases. Though some patients had more than one seizure type, all four had intractable complex partial seizures referable to the occipital lobe. All of the children demonstrated moderate or severe pervasive developmental delays.
CONCLUSIONS: Hypoglycemia in the neonatal period may cause a novel epilepsy syndrome in susceptible individuals. This syndrome is characterized by complex partial seizures originating from the occipital lobes with MRI evidence of atrophic changes in the occipital cortices. Seizures are difficult to control, and individuals experience pervasive delays in development. The epileptogenic and developmental consequences of neonatal hypoglycemia on the developing brain must be investigated further.