November 24, 2002
Diagnosis and Symptoms, Hypoglycemia
Question from Tuscaloosa, Alabama, USA:
A couple of years ago my 10 year old son, who has ADHD and frequent headaches, had an episode during which he fell to the floor, his hands cramped up, his arms cramped up, his eyes rolled back into his head and his face became distorted. He was unresponsive for about a minute. When I got him up, he was weak, and on the way to the hospital, he began vomiting. The doctors said that it sounded like a seizure and set up an appointment with a pediatric neurologist. The neurologist did an EEG about two weeks afterward, said that no seizure activity showed up, he thought that this was a behavior problem and that my son was faking it.
Recently the same exact thing happened, but I did not take him to the hospital. The next day, I took him to a walk-in clinic and the doctor checked his blood sugar. He had just eaten two fruit roll-ups and a bowl of lucky charms, but his blood sugar was only 68 mg/dl [3.8 mmol/L]. The doctor said that he thought that my son has he was hypoglycemia and told me to give him lots of proteins, carbohydrates and snacks between meals. He did lots of lab work all of which were normal. He said the diabetes test came out normal and that his sugar looked fine, but that he thinks that his blood sugar is bottoming out. He did not refer me to anyone so I called an endocrinologist who said that it sounded more like a neurological seizure and to take him to a pediatric neurologist. I am uncertain of whether I should take him to see a neurologist or an endocrinologist.
Answer:
It is impossible to know if these are hypoglycemic seizures since you would have to do a blood glucose check at the same time as the apparent seizure occurred – or immediately afterwards. Any delay in measuring blood glucose levels would not answer such a question.
Epilepsy can happen even with a normal EEG since the abnormal brain wave spikes can be intermittent. If your pediatrician and neurologist both believe this sounds like hypoglycemia, then a consultation with a pediatric endocrinologist or metabolism specialist would be reasonable. They could then teach you how to check blood glucose levels at home and see if there were any suspicious low values. Eating three meals and three snacks in a healthy fashion and staying away from simple/excess sugars and carbohydrates would also work if this was reactive hypoglycemia. If this is all some type of epilepsy or seizure disorder that is intermittent, It could be related to his ADHD or to his medications. Then a neurologist would be most helpful to sort this out. Sometimes a 24 hour EEG monitor shows up the abnormal brain waves when a single test does not show abnormalities.
SB
