Epilepsy And Hypoglycemia

What is epilepsy?

Epilepsy is a common neurological disorder characterised by frequent seizures. Seizures are the medical term for fits, which is derived from the Greek meaning “to take hold”.¹ It is a condition in which there is an abnormal electrical activity in the brain which results in a variety of symptoms. These symptoms vary according to the affected area of the brain. They include:²

• Jerky movement of arms or legs or becoming stiff
• Syncope(loss of consciousness)
• Upwards rolling of the eyes or staring
• Biting of the tongue
• Feeling unusual sensations such as strange odours, tastes, or tingling sensations in the body

According to the WHO, 50 million people in the world are diagnosed with epilepsy, which implies that it's a common condition worldwide.³ Around nine persons in 1,000 people in the UK are diagnosed with epilepsy each year, which indicates that around 633,000 people suffer from epilepsy each year.⁴ 

What are the causes of epilepsy?

One attack of seizures does not indicate that you currently have epilepsy. When two unprovoked seizures occur at least 24 hours apart, a diagnosis of epilepsy is made. The cause of unprovoked seizures are unclear, but there are secondary causes to epilepsy such as:⁵

• Trauma to the head
• Infections such as meningitis
• Congenital due to birth injury
• Brain tumour, brain vessel malformation

However, some triggers might be the cause for an attack of epilepsy. Examples of these triggers are:

• Drinking alcohol
• Being exposed to a sudden flash of bright lights
• Use of Illicit drugs
• Missing doses of antiseizure medications or overdosage
• Sleep deprivation
• Menstrual hormonal changes
• Stress
• Dehydration
• Skipping meals

What is hypoglycemia?

Hypoglycemia is low blood sugar level. Many people know hyperglycemia rather than hypoglycemia, as diabetic patients are liable to uncontrolled high blood sugar levels rather than low levels. However, hypoglycemia is considered much more dangerous than hyperglycemia, and its complications could be fatal.

If you are diabetic then you may have already been through the symptoms of hypoglycemia, but you may not have realised it. However, these symptoms are rare to occur in people without diabetes. These symptoms are:

• Feeling dizzy, drowsy, or nauseous
• Cold sweating
• Hands or arms shaking
• Tingling sensation in the lips
• Heart racing
• Blurry vision
• Feeling tired or confused

As soon as you have these symptoms, you can reverse it by having a sugary, easily swallowable food. Unfortunately, if hypoglycemia is severe, you may have seizures and its complications, where coma is the most common neurological complication. 

What are the causes of hypoglycemia?

There are possible causes for hypoglycemia with or without diabetes. The following table compares both:

What is the relationship between epilepsy and hypoglycemia?

Although being rare, seizures, as a complication of hypoglycemia, can happen. Significant variations in blood sugar levels, such as hypoglycemia or hyperglycemia, can change the hyperactivity of nerve cells (neurons), making seizures more likely. Nevertheless, there isn't enough proof to say that small variations in blood sugar levels (such as those between 50 and 200 mg/dl) that fall outside of the usual range cause seizures, as said by Dr. Orrin Devinsky, an expert neurologist specialising in epilepsy treatments in the USA.

It's also important to mention that seizures are not always witnessed, but patients usually visit their clinician and explain a temporary state of confusion or forgetfulness of events. Additionally, in children two-thirds of the cases have seizures at night and therefore are not witnessed.

In cases that were studied in some research, it was found that hypoglycemia triggers epileptic fits, especially in diabetic patients.⁶ Moreover, the extent and duration of hypoglycemia were found to increase the susceptibility of seizures if these factors vary.⁷ Nevertheless, hypoglycemia itself is not one of the causes of epilepsy, it is more of a trigger for it and its attacks can resemble clinically the attacks of one of the types of epilepsy which is the generalised tonic clonic type rather than focal seizures.

What is the difference between symptoms of epileptic fits and hypoglycemic attacks?

Hypoglycemia may cause seizures, which occasionally result in an incorrect diagnosis of epilepsy. Some features that may help differentiate repeated hypoglycemic episodes from epileptic seizures include sweating and prolonged duration of the attack. As it is well known, glucose is vital for all your body organs, your brain is extremely sensitive to any changes in blood glucose levels at which there are neurological disturbances that occur if slight changes happen.⁸ 

These neurological disturbances in response to hypoglycemia are misdiagnosed as epileptic seizures and are to be differentiated only by a special test called Electroencephalogram (EEG) which measures special waves of electricity in the brain that happen during hypoglycemia.

How can hypoglycemia induced epilepsy be controlled?

Maintaining stable glucose levels is achieved by the following:

Lifestyle modifications:

Regularly exercising, eating healthy, losing weight, and decreasing alcohol intake as well as smoking cessation have a positive impact in managing the epileptic attacks. It was believed that ketogenic diets can decrease the frequency of epilepsy especially in children, but now, antiepileptic drugs are the main line of prevention and treatment.⁹

Regular monitoring and compliance to medications:

It would be useful if you could learn how to measure your blood glucose level if you are diabetic and have experienced epileptic fits. Ask your clinician to guide you on how to use glucose measuring tools by doing a finger-prick test or by using an electronic blood sugar monitor called a flash glucose monitor or CGM. Compliance with your diabetic or antiepileptic medications helps in controlling the frequency of the attacks.

Having a seizure action plan:

Your family plays a key role in helping manage your seizures, providing support, recognizing triggers, and assisting with treatment. Their involvement ensures a safer, more effective approach to your care. Your ability to handle epilepsy depends on how well you handle challenges, knowledge about epilepsy, controlling seizures, and keeping yourself safe.

Plans for seizures can help you organise your information. It shows what symptoms you have, how your family should help during a seizure, and when to go to the hospital. Having a plan can help you prevent problems or tell others what to do during an emergency. You can adjust these plans to fit your life. Being prepared will help you live your life to the fullest without being stopped by seizures.¹⁰

Summary

Epilepsy, a neurological illness characterised by recurring seizures, affects approximately 50 million individuals worldwide. Symptoms include jerky movements, syncope, and odd sensations. Seizures can be caused by head injury, infections, brain tumours, or lifestyle choices such as alcohol abuse, strong lights, and sleep deprivation. Hypoglycemia, or low blood sugar, is a major concern, particularly for diabetics, and can induce dizziness, cold sweats, tremors and even convulsions if severe. Hypoglycemia can trigger epileptic fits, especially in diabetic individuals, however it is not a primary cause of epilepsy. Differentiating between epileptic seizures and hypoglycemia can be difficult, but investigations such as an electroencephalogram can help. To manage it, people need to make changes to their lifestyle, check their blood sugar levels more frequently and take their medicines according to their prescription. It is important to have a plan for what to do during a seizure to stay safe and to live a healthy life.