HYPOGLYCEMIA AND NEUROLOGICAL DISTURBANCES IN CHILDREN WITH DIABETES MELLITUS

Abstract

Abstract. Hypoglycemia with minor neurological as well as mental symptoms occurs in all children with diabetes mellitus. One third of these children, however, also show more pronounced symptoms, such as seizures and different degrees of lowered consciousness. 257 children and adolescents with diabetes mellitus and controlled at the Children's Hospital, Goteborg, Sweden, were examined by the author clinically and with neurophysiological methods such as electroencephalography and motor nerve conduction velocity during 1960 through 1973. Primary epilepsy occurred in 0.8% which is not different from 0.5% in the metabolically healthy population. On subgroups of the original material two studies have evolved, the second one being of special interest for this report. The study concerns 59 diabetic schoolchildren aged 7 through 15 years. Psychological items have been correlated to clinical and electroencephalographic (EEG) variables. Compared to controls the EEG of diabetic children presents lower alpha frequency, more non‐rhythmic low frequency activity and more paroxysmal (mainly epileptogenic) activity. These findings may be explained as being due partly to the general metabolic defect and partly to genetic factors. Five children showed a distinctly abnormal EEG‐pattern. These children can also characterize the general trend of a relation between severe hypoglycemic symptoms, behaviour disturbances, perceptual disturbances, emotional lability, cerebrolesional traits, and EEG with paroxysmal activity. The theory is submitted that a primary “diabetic encephalopathy” exists with an individual sensitivity to react with neurological symptoms in the presence of hypoglycemia. This sensitivity is dependent mainly upon basic genetic factors but is also dependent upon factors such as age, cerebral maturation as well as pre‐, peri‐ and postnatal ones. Mental symptoms are also more or less involved in this circuit. It is important to keep blood glucose at levels that avoid hypoglycemia in sensitive children. Sometimes the ordinary treatment must be fortified with an anti‐convulsive therapy.