Monthly Case

A 32-year-old male patient with massive overweight (140 kg at 178 cm height) underwent an operation with bypass of the stomach 12 months ago. Since then he had suffered from five tonic-clonic generalized epileptic seizures. Prior to seizures, the patient appears to be disorientated, he reports vegetative symptoms such as sweating. After two of these seizures, serum glucose was assessed and was significantly reduced to 40 and 42 mg/dl. Prior to adipositas surgery, the patient never had experienced epileptic seizures.

For clarification of the cause of seizures and for potential treatment, the patient presented in our outpatient clinic. 24-h-video-EEG and cMRI were normal. Following detailed history taking from the patient and his proxies and after critical acclaim of current and former paraclinical findings, we explained to the patient our interpretation. We think that the patient suffers from dumping syndrome after operation for stomach bypass (late dumping). When undigested carbahydrates move too rapidly into the small bowel, they are rapidly absorbed in the intestine resulting in hyperglycemia. This is followed by excretion of insulin, overshoot results in hypoglycemia. This is the pathophysiological basis for our patient’s vegetative symptoms and the subsequent tonic-clonic generalized epileptic seizure. After having explained these interrelations to the patient, he learnt to early identify the onset of hypoglycemic episodes and to immediately treat them with intake of dextrose. Since then no more epileptic seizures have occurred.

In summary, this patient suffers from late dumping syndrome resulting in acute-symptomatic epileptic seizures. Antiepileptic drug treatment is not necessary, as hypoglycemic episodes are now recognized and treated by the patient early. So, he can control and prevent occurrence of epileptic seizures.

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