Recurrent seizures

Chief Complaint A 35 y/o female ha h/o seizures and is on treatment for epilepsy for 2 and half years. History No other abnormalities noted. The patient is a little overweight from childhood. Vitals BP, Pulse and RR all vitals are Wnl Investigations Serum calcium was 5.98 mg/dL (reference interval 8.82–10.42 mg/dL) Serum phosphate was 7.51 mg/dL (1.86–4.34 mg/dL) PTH was 190 pg/mL (12.03–87.9 pg/mL) Vitamin D (Total 25-OH; 25-OH D2 and D3) Magnesium, Renal function and liver tests were all normal. Diagnosis Need your opinion on this Treatment Please advise

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Seizures likely secondary to hypocalcaemia. The bone profile fits best with secondary hyperparathyroidism. The most common cause is renal failure however her renal function is fine. Hyperphosphataemia could also explain those derangements, which could be caused by a number of things including uncommon metabolic disorders e.g. pseudohypoparathyroidism. Patient needs IV calcium gluconate.

Hyperparathyroidism Secondary hyperparathyroidism, since serum calcium is low and phosphate is high..However Ionic calcium should be checked . Such situation can happen when diet is rich in phosphates which binds with calcium preventing its absorption.So hypocalcemia is caused ,and PTH levels are increased. Other causes of hypocalcemia are Renal impairment, renal acidosis ,which need to be excluded. Seizure may or may not be related to this. ? Needs MRI / CT neck to rule out parathyroid nodules MRI brain ,EEG to exclude IC causes for seizures .

Thank you,Doctor

No information related to seizure Onset , focal or generalised ? Drug ? Compliance ? Investigation s/o hypocalcemia with hyperparathyroidism Visit near by neurologist and if required endocrinologist

Osteomalacia from chronic ingestion of anticonvulsant

It's hypocalcemia with secondary compensatory hyperparathyroidism, not the other way around, look for signs of hypocalcemia like chovstek and trousesu,carpopedal spasm, Hypocalcemia can be due drugs like phenytoin or carbamazepine, But Since she is obese other hormonal profile to look for endocrine dysplasia to be checked out

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