1
|
Nangia A, Saravanan JS, Hazra S, Priya V, Sudesh R, Rana SS, Ahmad F. Exploring the clinical connections between epilepsy and diabetes mellitus: Promising therapeutic strategies utilizing agmatine and metformin. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03295-1. [PMID: 39066910 DOI: 10.1007/s00210-024-03295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Diabetes mellitus (DM) and epilepsy and the psychological and socio-economic implications that are associated with their treatments can be quite perplexing. Metformin is an antihyperglycemic medication that is used to treat type 2 DM. In addition, metformin elicits protective actions against multiple diseases, including neurodegeneration and epilepsy. Recent studies indicate that metformin alters the resident gut microbiota in favor of species producing agmatine, an arginine metabolite which, in addition to beneficially altering metabolic pathways, is a potent neuroprotectant and neuromodulant. METHODS We first examine the literature for epidemiological and clinical evidences linking DM and epilepsy. Next, basing our analyses on published literature, we propose the possible complementarity of agmatine and metformin in the treatment of DM and epilepsy. RESULTS Our analyses of the clinical data suggest a significant association between pathogeneses of epilepsy and DM. Further, both agmatine and metformin appear to be multimodal therapeutic agents and have robust antiepileptogenic and antidiabetic properties. Data from animal and clinical studies largely support the use of metformin/agmatine as a double-edged pharmacotherapeutic agent against DM and epilepsy, particularly in their concurrent pathological occurrences. CONCLUSION The present review explores the evidences and available data on possible uses of metformin/agmatine as pertinent antidiabetic and antiepileptic agents. Our hope is that this will stimulate further research on the therapeutic actions of these multimodal agents, particularly for subject-specific clinical outcomes.
Collapse
Affiliation(s)
- Aayushi Nangia
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Janani Srividya Saravanan
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Shruti Hazra
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Vijayan Priya
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Ravi Sudesh
- Department of Biomedical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Sandeep Singh Rana
- Department of Biosciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India
| | - Faraz Ahmad
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632014, India.
| |
Collapse
|
2
|
Zhu M, Ling S. Potential causal association of diabetes mellitus and blood glucose related indexes with the onset of epilepsy: a two-sample Mendelian randomization study. Front Neurol 2024; 15:1399504. [PMID: 38962478 PMCID: PMC11221190 DOI: 10.3389/fneur.2024.1399504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
Aim Diabetes mellitus (DM) may promote the occurrence of epilepsy through mechanisms, such as inflammation, immune imbalance, and cerebrovascular injury, caused by metabolic abnormalities. However, evidence for the effects of DM and blood glucose (BG) on the risk of epilepsy is limited. Herein, this study used the Mendelian randomization (MR) method to investigate the potential causal associations of DM and BG-related indexes with epilepsy. Methods In this two-sample MR study, summary statistics data of the genome-wide association studies (GWASs) on exposures, including type 1 diabetes mellitus (T1DM), T2DM, fasting glucose, and glycated hemoglobin (HbAlc), were extracted from the MRC-Integrative Epidemiology Unit (MRC-IEU). The GWAS data on study outcomes, including epilepsy, focal epilepsy, and generalized epilepsy, were obtained from the FinnGen consortium. MR-Egger regression was used to examine horizontal pleiotropism of instrumental variables (IVs), and Cochran's Q statistics was used to quantify the heterogeneity. MR analysis methods including inverse variance weighted (IVW) tests, weighted median, and MR-Egger were utilized to investigate the causal associations between DM and BG-related indexes with epilepsy. The evaluation indexes were odds ratios (ORs) and 95% confidence intervals (CIs). Reverse causal association analyses were also performed. In addition, IVW-radial and leave-one-out tests were utilized for sensitivity analyses. Results IVW estimates suggested that T1DM has potential causal associations with epilepsy (OR = 1.057, 95% CI: 1.031-1.084) and generalized epilepsy (OR = 1.066, 95% CI: 1.018-1.116). No significant reverse causal associations of T1DM with epilepsy or generalized epilepsy were found (all P > 0.05). In addition, sensitivity analysis results identified no outlier, indicating that the associations of T1DM with epilepsy and generalized epilepsy were relatively robust. Conclusion Patients with T1DM had a potential risk of developing epilepsy, and prompt treatment of DM and dynamic monitoring may be beneficial to prevent epilepsy in this high-risk population. However, the causal associations of DM and BG with epilepsy may warrant further verification.
Collapse
Affiliation(s)
- Mengting Zhu
- Department of Neurology, The Fifth People's Hospital of Wujiang District, Suzhou, Jiangsu, China
| | | |
Collapse
|
3
|
Imaichi Y, Nakatani E, Fukutomi Y, Kuriyama N, Mori K, Sugawara A. Leukotriene antagonists reduce epileptic seizures-related hospitalization in older adult populations with allergic rhinitis or asthma: A population-based cohort study using the Shizuoka Kokuho database: The Shizuoka study. Epilepsia Open 2024; 9:200-209. [PMID: 37881138 PMCID: PMC10839289 DOI: 10.1002/epi4.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Managing the risk of epileptic seizures in older adults is increasingly important as the population ages. Leukotriene receptor antagonists (LTRAs) are commonly used to treat asthma or allergic rhinitis. Preclinical studies suggest that LTRAs have antiepileptic effects; however, few population-based etiological studies on this topic have been available. Our study explored whether LTRAs reduce hospitalization risk associated with epileptic seizures in older individuals with asthma or allergic rhinitis. METHODS We conducted a new-user design analysis using the Shizuoka Kokuho database. We included all individuals aged 60-89 years who had at least one episode of allergic rhinitis or asthma during the study period. We compared individuals who newly started LTRAs with those who did not take LTRAs. Propensity score matching was used to balance the baseline characteristics of the participants. We compared the hazard ratios for seizure-related hospitalization between new LTRA users and non-users and performed subgroup analyses. RESULTS Our matched cohorts consisted of 64 724 new users and non-users of LTRAs who were aged 60-89 years and had asthma or allergic rhinitis. During the observation period, 377 (0.58%) and 595 (0.92%) incidents were observed in the LTRA new-user and non-user groups, respectively. The hazard ratio for seizure-related hospitalization was 0.75 (95% confidence interval [CI]: 0.62-0.92) in the LTRA new-user group compared with the non-user group. Subgroup analysis revealed that the hazard ratio was weak in diabetic patients (1.31; 95% CI: 0.72-2.38). SIGNIFICANCE This study indicated that LTRAs reduced seizure-related hospitalization in older adult patients with allergic rhinitis or asthma. We could not evaluate the severity and related diseases of epileptic seizures during LTRAs. Further studies, including observational studies, detailed multicenter prospective studies, and clinical trials, are needed to validate these findings. PLAIN LANGUAGE SUMMARY This study examined if leukotriene receptor antagonists (LTRAs), commonly used for asthma or allergies, could lower seizure risk in older adults. Analyzing health records of 60-89 year-olds with asthma or allergies, we found a reduced rate of seizure-related hospitalizations in those starting LTRAs, though this was not as evident in diabetic patients. Our results suggest potential benefits of LTRAs in preventing seizures in older adults with respiratory issues, but further research is needed to confirm these findings.
Collapse
Affiliation(s)
- Yutaro Imaichi
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
- Department of PediatricsSeirei Mikatahara General HospitalHamamatsu, ShizuokaJapan
| | - Eiji Nakatani
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and RheumatologyNational Hospital Organization Sagamihara National HospitalKanagawaJapan
| | - Nagato Kuriyama
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
| | - Kiyoshi Mori
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
| | - Akira Sugawara
- Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuokaJapan
| |
Collapse
|
4
|
Nadeem MD, Memon S, Qureshi K, Farooq U, Memon UA, Aparna F, Kachhadia MP, Shahzeen F, Ali S, Varrassi G, Kumar L, Kumar S, Kumar S, Khatri M. Seizing the Connection: Exploring the Interplay Between Epilepsy and Glycemic Control in Diabetes Management. Cureus 2023; 15:e45606. [PMID: 37868449 PMCID: PMC10588297 DOI: 10.7759/cureus.45606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Epilepsy, a neurological disorder characterized by recurrent seizures, and diabetes, a metabolic disorder characterized by impaired regulation of glucose levels, are two distinct conditions that may appear unrelated at first glance. Nevertheless, recent scholarly investigations have revealed these entities' intricate and ever-evolving interplay. This review initially delves into the intricate interplay between epilepsy and its potential ramifications on glycemic control. Seizures, particularly those accompanied by convulsive manifestations, have the potential to induce acute perturbations in blood glucose levels via diverse mechanisms, encompassing the liberation of stress hormones, the emergence of insulin resistance, and the dysregulation of the autonomic nervous system. Comprehending these intricate mechanisms is paramount in customizing productive strategies for managing diabetes in individuals with epilepsy. On the contrary, it is worth noting that diabetes can substantially impact the trajectory and control of epilepsy. The correlation between hyperglycemia and an elevated susceptibility to seizures, as well as the potential for exacerbating the intensity of epilepsy, has been established. This narrative review offers a concise exposition of the intricate interplay between epilepsy and glycemic control within diabetes management. The objective of exploring reciprocal influences, underlying mechanisms, and common risk factors is to augment the clinical comprehension of this intricate interconnection. In essence, this acquired knowledge possesses the potential to serve as a guiding compass for healthcare professionals, enabling them to craft bespoke therapeutic approaches that enhance the holistic welfare of individuals grappling with the coexistence of epilepsy and diabetes.
Collapse
Affiliation(s)
| | - Siraj Memon
- Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, PAK
| | - Kashifa Qureshi
- Medicine, Liaquat University of Medical & Health Sciences, Jamshoro, PAK
| | - Umer Farooq
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Unaib Ahmed Memon
- Neurology and Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fnu Aparna
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | | | - Fnu Shahzeen
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Sameer Ali
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Lakshya Kumar
- General Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Sumeet Kumar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
5
|
Bartolini E, Ferrari AR, Fiori S, Della Vecchia S. Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review. J Clin Med 2023; 12:jcm12072580. [PMID: 37048663 PMCID: PMC10095009 DOI: 10.3390/jcm12072580] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/20/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023] Open
Abstract
Cerebral excitability and systemic metabolic balance are closely interconnected. Energy supply to neurons depends critically on glucose, whose fluctuations can promote immediate hyperexcitability resulting in acute symptomatic seizures. On the other hand, chronic disorders of sugar metabolism (e.g., diabetes mellitus) are often associated with long-term epilepsy. In this paper, we aim to review the existing knowledge on the association between acute and chronic glycaemic imbalances (hyper- and hypoglycaemia) with seizures and epilepsy, especially in the developing brain, focusing on clinical and instrumental features in order to optimize the care of children and adolescents and prevent the development of chronic neurological conditions in young patients.
Collapse
Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy (A.R.F.)
- Tuscany PhD Programme in Neurosciences, 50139 Florence, Italy
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy (A.R.F.)
| | - Simona Fiori
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy (A.R.F.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56128 Pisa, Italy
| | - Stefania Della Vecchia
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Pisa, Italy (A.R.F.)
- Department of Molecular Medicine and Neurogenetics, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
- Correspondence: ; Tel.: +39-050-886-332
| |
Collapse
|
6
|
Pappas A, Kubsad S, Baud MO, Wright KE, Kollmyer DM, Warner NM, Haltiner AM, Gwinn RP, Doherty MJ. Does glucose influence multidien cycles of interictal and/or ictal activities? Seizure 2021; 85:145-150. [PMID: 33465639 DOI: 10.1016/j.seizure.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE There are multidien patterns of seizure occurrence. Predicting seizure risk may be easier with biomarker correlates to multidien patterns. We hypothesize multiday hyper or hypoglycemia contributes to seizure risk. METHODS In a type I diabetic (T1D) with focal onset epilepsy with continuous glucose monitoring (CGM) and responsive neurostimulation (RNS) devices, we studied multiday interictal activities (IEA), seizures, and glucose. Hourly CGM data was matched to hourly RNS captures of interictal and ictal activities over 33 months. RNS detection settings were unchanged. Multidien cycles were analyzed, active blocks of IEA and ictal episodes defined, and tissue glucose averages studied. RESULTS Average glucose was 161 mg/dl. A 40-day cycle of interictal and ictal activities occurred, though no similar glucose cycle was evident. Glucose elevations relative to patient average were associated with increases in IEA but not seizure. Frequent seizures were not associated with obvious elevations or decreases of glucose from baseline, most seizures occurred at +/- 10 mg/dl of average daily glucose (i.e. 150-170 mg/dl). CONCLUSION Tissue glucose may influence IEA but may not influence multiday seizure activity or very frequent seizures. In an ambulatory T1D patient multiday hypo or hyperglycemic extremes do not appear to provoke seizure activities.
Collapse
Affiliation(s)
- Alexa Pappas
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Los Angeles, CA, USA
| | - Sanjay Kubsad
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Maxime O Baud
- Wyss Center for Bio and Neuroengineering, Geneva, 1202, Switzerland; Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, 3010, Switzerland
| | | | | | - Nicole M Warner
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Alan M Haltiner
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Ryder P Gwinn
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA
| | - Michael J Doherty
- Swedish Epilepsy Center, 550 17th Ave suite 540, Seattle, WA, 98122, USA.
| |
Collapse
|
7
|
Sillanpää M, Saarinen MM, Rönnemaa T, Gissler M, Schmidt D. Overrepresentation of epilepsy in children with type 1 diabetes is declining in a longitudinal population study in Finland. Acta Paediatr 2019; 108:2235-2240. [PMID: 31218734 DOI: 10.1111/apa.14910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
AIM The aim was to determine temporal changes in increased risk of epilepsy among children with type 1 diabetes. METHODS The incidence of epilepsy up to age 15 in children with prior type 1 diabetes was analysed regarding the general Finnish child population using data from the Finnish nationwide hospital register. Type 1 diabetes and epilepsy were identified by the International Classification of Diseases 9th and 10th revision codes. Epilepsy was defined according to ILAE guidelines. The analyses were done using negative binomial regression models. RESULTS Preceding type 1 diabetes was diagnosed in 6162 (0.91%) of the 679 375 general children population. Incidence rate of new-onset epilepsy among children with type 1 diabetes was higher than in controls (140 vs 82 per 100 000 person-years at risk, respectively). The excess incidence diminished with time (P = 0.033 for diabetes to birth cohort interaction), from over twofold in birth cohort 1990-1993 [incidence rate ratio 2.2 (95% CI 1.7-2.9)] to 40% in birth cohort 1998-2000 [1.4 (95% CI 1.001-1.9)]. CONCLUSION In a population study setting, children with type 1 diabetes had an increased, but slowly declining risk of developing epilepsy. Future research may elucidate the underlying mechanisms.
Collapse
Affiliation(s)
- Matti Sillanpää
- Department of Child Neurology University of Turku and Turku University Hospital Turku Finland
- Department of General Practice University of Turku and Turku University Hospital Turku Finland
| | - Maiju M. Saarinen
- Department of Child Neurology University of Turku and Turku University Hospital Turku Finland
- Department of General Practice University of Turku and Turku University Hospital Turku Finland
- Doctoral Programme of Clinical Research University of Turku Turku Finland
| | - Tapani Rönnemaa
- Department of Medicine University of Turku and Turku University Hospital Turku Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL) Helsinki Finland
- Research Centre for Child Psychiatry University of Turku Turku Finland
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine Karolinska Institute Stockholm Sweden
| | | |
Collapse
|
8
|
Bartolini E, Sander JW. Dealing with the storm: An overview of seizure precipitants and spontaneous seizure worsening in drug-resistant epilepsy. Epilepsy Behav 2019; 97:212-218. [PMID: 31254841 DOI: 10.1016/j.yebeh.2019.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
In drug-resistant epilepsy, periods of seizure stability may alternate with abrupt worsening, with frequent seizures limiting the individual's independence and physical, social, and psychological well-being. Here, we review the literature focusing on different clinical scenarios related to seizure aggravation in people with drug-resistant epilepsy. The role of antiseizure medication (ASM) changes is examined, especially focusing on paradoxical seizure aggravation after increased treatment. The external provocative factors that unbalance the brittle equilibrium of seizure control are reviewed, distinguishing between unspecific triggering factors, specific precipitants, and 'reflex' mechanisms. The chance of intervening surgical or medical conditions, including somatic comorbidities and epilepsy surgery failure, causing increased seizures is discussed. Spontaneous exacerbation is also explored, emphasizing recent findings on subject-specific circadian and ultradian rhythms. Awareness of external precipitants and understanding the subject-specific spontaneous epilepsy course may allow individuals to modify their lifestyles. It also allows clinicians to counsel appropriately and to institute suitable medical treatment to avoid sudden loss of seizure control.
Collapse
Affiliation(s)
- Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, via suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Achterweg 5, Heemstede 2103 SW, the Netherlands.
| |
Collapse
|
9
|
Yan D, Zhao E, Zhang H, Luo X, Du Y. Association between type 1 diabetes mellitus and risk of epilepsy: A meta-analysis of observational studies. Drug Discov Ther 2019; 11:146-151. [PMID: 28757515 DOI: 10.5582/ddt.2017.01020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A potential association between type 1 diabetes mellitus and subsequent epilepsy emerged in recent studies. This study aimed to evaluate the possible relationship between type 1 diabetes mellitus and epilepsy using meta-analysis. Pubmed, ISI Web of Knowledge, Embase and Cochrane Library were searched for potential studies of the association between type 1 diabetes mellitus and epilepsy from inception to February 1, 2017. Two investigators independently screened studies for inclusion and extracted related data; discrepancies were solved by consensus. Random effects model of Hazard Ratio (HR) was used to estimate the strength of association. We identified 13 papers from potentially relevant articles of which 3 cohort studies met the inclusion criteria. Random effects meta-analysis showed that type 1 diabetes mellitus was associated with an increased risk of epilepsy with HR = 3.29 (95% CI: 2.61-4.14; I2 = 0, p = 0.689). Similar results were observed in type 1 diabetes mellitus patents younger than 18-years-old with HR = 2.96 (95% CI: 2.28-3.84; I2 = 0, p = 0.571). Meta-analysis of 2 studies that adjusted for potential confounders yielded an increased risk of epilepsy with HR = 2.89 (95% CI: 2.26-3.70; I2 = 0, p = 0.831). The meta-analysis indicates that type 1 diabetes mellitus is associated with a statistically significant increased risk for epilepsy compared to those without type 1 diabetes mellitus.
Collapse
Affiliation(s)
- Dandan Yan
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University
| | - Enfa Zhao
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University
| | - Hong Zhang
- Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University
| | - Xiaohui Luo
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University
| | - Yajuan Du
- Department of Structural Heart Disease, the First Affiliated Hospital of Xi'an Jiaotong University
| |
Collapse
|
10
|
Mastrangelo M, Tromba V, Silvestri F, Costantino F. Epilepsy in children with type 1 diabetes mellitus: Pathophysiological basis and clinical hallmarks. Eur J Paediatr Neurol 2019; 23:240-247. [PMID: 30600130 DOI: 10.1016/j.ejpn.2018.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
We provide an overview on the current knowledge about the association between epilepsy and type 1 diabetes mellitus (T1DM). People with T1DM have a 2-6-fold higher risk of epilepsy than the general population. The onset of T1DM anticipates the onset of epilepsy by a mean period between 1,5 and 2,8 years. These two disorders share four potential distinct pathogenic factors: a) genetic predisposition; b) factors involved in autoimmune responses (i.e. anti-glutamic acid decarboxylase antibodies-GADAbs); c) effects of hypo/hyperglycaemia; d) cerebrovascular damages resulting in ischaemic processes. Seizures semiology prominently includes focal (up to patterns of epilepsia partialis continua) or secondarily generalized seizures but also reflex seizures and various forms of generalized seizures. EEG abnormalities are more common in people with an inappropriate metabolic control with a prominent involvement of fronto-temporal regions. Epilepsy management does not differ between patients with and without diabetes and insulin, nutritional recommendations and physical activity may also produce significant benefits on seizures control. Possible therapeutic alternatives in selected cases include immunosuppressive drugs (in patients with GADAbs) and ketogenic diet.
Collapse
Affiliation(s)
- Mario Mastrangelo
- Division of Infantile Neurology, Department of Human Neurosciences, Sapienza University of Rome, Italy.
| | - Valeria Tromba
- Pediatric Diabetology Unit, Department of Maternal and Infantile Health, Sapienza University of Rome, Italy
| | - Francesca Silvestri
- Pediatric Diabetology Unit, Department of Maternal and Infantile Health, Sapienza University of Rome, Italy
| | - Francesco Costantino
- Pediatric Diabetology Unit, Department of Maternal and Infantile Health, Sapienza University of Rome, Italy
| |
Collapse
|
11
|
Amanat M, Thijs RD, Salehi M, Sander JW. Seizures as a clinical manifestation in somatic autoimmune disorders. Seizure 2019; 64:59-64. [DOI: 10.1016/j.seizure.2018.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
|
12
|
Kinnear KM, Warner NM, Haltiner AM, Doherty MJ. Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset. EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:65-70. [PMID: 30073145 PMCID: PMC6068315 DOI: 10.1016/j.ebcr.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/27/2018] [Accepted: 03/12/2018] [Indexed: 01/14/2023]
Abstract
Objectives To investigate if glucose levels influence seizure patterns. Materials and methods In a patient with RNS/NeuroPace implanted bi-temporally and type 1 diabetes mellitus, seizure event times and onset locations were matched to continuous tissue glucose. Results Left focal seizure (LFS, n = 22) glucoses averaged 169 mg/dL, while right focal seizure (RFS, n = 23) glucoses averaged 131 mg/dL (p = 0.03). LFS occurred at mean time 17:02 while RFS occurred at 04:23. LFS spread to the contralateral side (n = 19) more than RFS (n = 2). Conclusion Seizure onset laterality and spread vary with glucose and time of seizure.
Collapse
|
13
|
Lu CL, Chang YH, Sun Y, Li CY. A population-based study of epilepsy incidence in association with type 2 diabetes and severe hypoglycaemia. Diabetes Res Clin Pract 2018; 140:97-106. [PMID: 29608979 DOI: 10.1016/j.diabres.2018.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/27/2018] [Accepted: 03/15/2018] [Indexed: 11/21/2022]
Abstract
AIMS This study was conducted to investigate potential link between type 2 diabetes mellitus (T2DM) and epilepsy, and the role of severe hypoglycaemia (SH) might play in the relationship. METHODS This was a cohort study based on Taiwan's National Health insurance claims. Totally 751,792 people with T2DM and 824,253 matched controls were identified in 2002-2003 and followed to incidence of epilepsy or end of 2011. We used Cox proportional hazard model to relate epilepsy incidence to separate and joint effects of T2DM and SH. A possible mediation effect of SH on the association between T2DM and epilepsy was analyzed. RESULTS Over a 10-year follow-up, patients with T2DM had a higher incidence rate of epilepsy than controls (35.0 vs 21.9 per 10,000 person-years). After controlling for potential confounders including SH, T2DM increased the hazard of epilepsy by some 50%. The stratified analysis further indicated that T2DM (hazard ratio (HR)=1.44, 95% confidence interval (CI) = 1.40-1.47), and SH (HR = 2.22, 95% CI = 1.76-2.81) were both independent risk factors for epilepsy. SH did not modify but mediated 12% of the association between T2DM and epilepsy. CONCLUSION Our findings supported that SH may increase the risk of epilepsy, and that T2DM may increase risk of epilepsy independent of SH.
Collapse
Affiliation(s)
- Chin-Li Lu
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, Sanxia District, New Taipei City, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
| |
Collapse
|
14
|
Dafoulas GE, Toulis KA, Mccorry D, Kumarendran B, Thomas GN, Willis BH, Gokhale K, Gkoutos G, Narendran P, Nirantharakumar K. Type 1 diabetes mellitus and risk of incident epilepsy: a population-based, open-cohort study. Diabetologia 2017; 60:258-261. [PMID: 27796422 PMCID: PMC6518067 DOI: 10.1007/s00125-016-4142-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The aim of this research was to explore the relationship between incident epilepsy and type 1 diabetes in British participants. METHODS Using The Health Improvement Network database, we conducted a retrospective, open-cohort study. Patients who were newly diagnosed with type 1 diabetes mellitus at the age of ≤40 years were identified and followed-up from 1 January 1990 to 15 September 2015. These patients, identified as not suffering from epilepsy at the time of diagnosis, were randomly matched with up to four individuals without type 1 diabetes mellitus, based on age, sex and participating general practice. A Cox regression analysis was subsequently performed using Townsend deprivation index, cerebral palsy, head injury and learning disabilities as model covariates. RESULTS The study population consisted of a total of 24,610 individuals (4922 with type 1 diabetes and 19,688 controls). These individuals were followed up for a mean of 5.4 years (approximately 132,000 person-years of follow up). Patients with type 1 diabetes were significantly more likely to be diagnosed with epilepsy during the observation period compared with controls (crude HR [95% CI]: 3.02 [1.95, 4.69]). The incidence rate was estimated to be 132 and 44 per 100,000 person-years in patients and controls, respectively. This finding persisted after adjusting for model covariates (adjusted HR [95% CI]: 3.01 [1.93, 4.68]) and was also robust to sensitivity analysis, excluding adult-onset type 1 diabetes mellitus. CONCLUSIONS/INTERPRETATION Patients with type 1 diabetes are at approximately three-times greater risk of developing epilepsy compared with matched controls without type 1 diabetes. This should be considered when investigating seizure-related disorders in patients with type 1 diabetes mellitus.
Collapse
Affiliation(s)
- George E Dafoulas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- First Department of Propaedeutic Internal Medicine, Diabetes Center, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos A Toulis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, 424 General Army Training Hospital, Thessaloniki, Greece
| | - Dougall Mccorry
- Department of Neuroscience, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - George Gkoutos
- Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Parth Narendran
- Centre for Endocrinology, Diabetes and Metabolism, Institute of Metabolism and Systems Research, University of Birmingham, Room 229, Medical School, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, UK.
- University of Birmingham, Birmingham, UK.
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University of Birmingham, Birmingham, UK
| |
Collapse
|
15
|
Kalra S, Unnikrishnan AG, Gupta Y. Epileptogenicity of diabetes and antiepileptogenicity of ketogenic states: Clarity or confusion? Indian J Endocrinol Metab 2016; 20:583-585. [PMID: 27730063 PMCID: PMC5040033 DOI: 10.4103/2230-8210.190520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | | | | |
Collapse
|
16
|
Chou IC, Kao CH. The intriguing relationship between epilepsy and type 1 diabetes mellitus. Reply to Sander JW, Novy J, Keezer MR [letter]. Diabetologia 2016; 59:1571-1572. [PMID: 27193914 DOI: 10.1007/s00125-016-3999-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Affiliation(s)
- I-Ching Chou
- Department of Pediatric Neurology, China Medical University Children's Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan.
| |
Collapse
|