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- Title
Comorbidity and metabolic context are crucial factors determining neurological sequelae of hypoglycaemia.
- Authors
GATAULLINA, SVETLANA; DELLATOLAS, GEORGES; PERDRY, HERVÉ; ROBERT, JEAN-JACQUES; VALAYANNOPOULOS, VASSILI; TOUATI, GUY; OTTOLENGHI, CHRIS; DULAC, OLIVIER; DE LONLAY, PASCALE
- Abstract
Aim To determine risk factors for neurological sequelae following hypoglycemia. Method We analysed the neurological outcome in 164 patients (mean age 10y 10mo, SD 5.9) following hypoglycemia due to three diseases with various metabolic contexts, different ages at onset, and combinations with comorbidity (fever/infection, hypoxia/ischemia): glycogen storage disease type I (GSDI) (21 patients, mean age at first hypoglycemic episode 3.8mo, SD 3.5); fatty acid β-oxidation defects (FAOD) (29 patients, mean age at first hypoglycemic episode 14.8mo, SD 12.6); and hyperinsulinism (HIns) (114 patients, mean age at first hypoglycemic episode 2.3mo, SD 4.7). Results Risk factors of poor neurological outcome were aetiology ( p<0.006), comorbidity ( p<0.001), and prolonged convulsions ( p<0.001). Ordinal logistic regression showed that comorbidity ( p<0.001) and status epilepticus ( p=0.002) were the main determinants of sequelae. Asymptomatic hypoglycemia did not lead to sequelae, whatever the aetiology. Age was not correlated to sequelae, whatever the aetiology. The highest prevalence of hypoglycemic sequelae was found in FAOD and HIns combined with comorbidity, the lowest in GSDI ( p<0.001) in which hypoglycemia is often asymptomatic, associated with increased plasma lactate, and rarely combined with comorbidity. Interpretation Hypoglycemia is severely deleterious for the brain in the context of fever/infection and/or hypoxia/ischemia, and status epilepticus. The metabolic context providing alternative fuels may improve neurological outcome.
- Subjects
HYPOGLYCEMIA; DISEASE complications; METABOLISM; ETIOLOGY of diseases; STATUS epilepticus; HEALTH outcome assessment; DISEASE risk factors
- Publication
Developmental Medicine & Child Neurology, 2012, Vol 54, Issue 11, p1012
- ISSN
0012-1622
- Publication type
Article
- DOI
10.1111/j.1469-8749.2012.04400.x