Adult onset recurrent seizures as the first presentation of Primary Hypoparathyroidism

Introduction: Hypoparathyroidism leading to hypocalcemia is an important treatable cause of recurrent seizures. Primary hypoparathyroidism presenting for the first time as seizures in adulthood is quite infrequent. Patients may present with hypocalcemic seizures even in the absence of subtle hypocalcemic signs. Case report: A 30 year old male, was presented to the emergency facility in an unconscious condition. He was intubated on the way to the hospital as he had suffered from two episodes of ventricular tachycardia. He had previous history of recurrent seizures for 6 years inspite of multiple anticonvulsants including phenytoin sodium, sodium valproate, and levetiracetam. The seizure frequency increased in the last year and he would have 5-6 episodes/ month. A MRI brain scan and EEG at the onset were both normal, as was the general examination but he had history of bilateral cataracts. There were no signs of tetany. Investigations revealed a normal hemoglobin and glucose level with normal electrolytes and both TLC and DLC levels were also normal. He had a serum calcium level of 3.3 mg% with a serum parathyroid hormone level of 1pg/ml, serum 25(OH) vitamin D levels of 6.6ng/ml and hypomagnesemia. NCCT head scan showed bilateral basal ganglia, and deep white matter calcification. Conclusions: 1) Ironically, increasing reliance on high end investigations such as a MRI brain scan could lead to certain conditions being missed; conditions that could be easily identifiable by the humble CT scan. 2) All treatable metabolic conditions should be excluded at first before commencing with anticonvulsants; this will restrict patients from burdensome polytherapy and related side effects.