Thread by @hyderabaddoctor

Recurrent seizures: Consider Vitamin B12 deficiency, if cause is not obvious

#Vitamin #B12 plays a vital role in keeping nervous system healthy. Deficiency of B12 can lead to dementia, neuropathy, spinal cord disease and psychosis. Here I report a case of #Epilepsy .
#MedTwitter

2. I saw this patient in 2004, when vitamin B12 deficiency was not an established cause of seizures. This young man had features of behavioral changes, dementia and seizures. Treatment with risperidone and carbamazepine did not result in improvement.
#neurotwitter #nutrition

3. Suspecting vitamin B12 deficiency, blood investigations confirmed the diagnosis- high MCV, low vitamin B12, hypersegmented polymorphs, intrinsic factor antibody +, antral biopsy proven atrophic gastritis. CT brain showed mild cerebral atrophy.

4. He was treated with vitamin B12 injections to start with followed by oral tablets. He became seizure-free after one month, & remained seizure free for next 23 months of follow up. Risperidone and carbamazepine were gradually withdrawn. His cognition and behavior also improved.

5. Possible mechanism of epileptogenesis: Abnormal neurons with destroyed myelin sheaths may be more prone to excitatory effects of glutamate.

6. Take home message: Consider vitamin B12 deficiency in cases of recurrent seizures when no other cause is apparent, especially if the patient additionally has dementia, psychosis or neuropathy. My original research paper published in 2004 has so far received about 70 citations.