Agitation and Sugar-Craving Related to Epilepsy: A Case Report

Case Presentation

A 12-year-old boy was presented with difficulty in concentration and regulating emotions, impulse control and regulation of activity and sleep. He was speculated for Attention deficit hyperactivity disorder (ADHD)

Medical History

The patient was a resident of a foster home since the age of eight months.
On being adopted by his foster family, he was found to be malnourished and dehydrated. He was also sleeping for about 18 hours a day.
He had struggled with anxiety, concentration and impulsivity as proved by his previous examination at the clinic.
The patient demonstrated a tendency of getting tired quickly and would suddenly fall asleep while he was in school or in the middle of performing an activity.
He would often experience visual disturbances and headaches when he was tired.
He faced difficulties in interpreting messages and following instructions and it was also observed that his emotions would fluctuate rapidly and become intense.
The patient had been assessed for sleep-disorders but no indication of hypersomnia or sleep apnea syndrome could be detected.
However, he was experiencing insomnia and had a poor sleep quality.

Clinical Exam

His physical examination revealed:

Cardiac, pulmonary and abdominal findings: Normal
Diadochokinesis test: Scored 5 points and demonstrated jerky and slow movements on both sides
Finger opposition test: Scored 5 points and displayed slow and slightly uneven left-sided mirror movements
Walking on the lateral side of the foot: Scored 2 points and had a relaxed extremity bilaterally

Psychological examination revealed:

Test	Result
Ability test (WISC-IV)	Intellectual abilities: Below the normal range for the given age.Verbal comprehension index: Low scoresDuring testing, the patient showed good concentration during the first few minutes but decreasing concentration and increasing motor turbulence was observed beyond testing
Kiddie SADS	Criteria for attention deficit: 8/9 satisfiedSymptoms were found to be present for >6 months and had been present before the age of 7Oppositional defiant criteria: 6/8Symptoms caused a significant amount of social impairment
Playing Observation	No clear sign of inattention or inactivity was observed
BRIEF	The tests from home and school indicated executive difficulties
Barkley	Barkley test from home: Difficulties with attention, hyperactivity and impulsivityBarkley test from school: No clinical significance

Table 1: Results of Psychological Tests

Laboratory evaluation revealed:

Test	Result
Hemoglobin	13.5 g/dL
Hematocrit	0.40
Erythrocytes	4.5 x10¹²/L
Leukocytes	4.5 x10⁹/L
Platelets	313 x10⁹/L
Neutrophils	2 x10⁹/L
Lymphocyte	2.1 x10⁹/L
Monocytes	0.3 x10⁹/L
Eosinophils	0.1 x10⁹/L
Basophils	0
Sodium	141 mmol/L
Potassium	4.8 mmol/L
Calcium	2.54 mmol/L
25-OH vitamin D	78 mmol/L
Glucose	4.1 mmol/L
Creatinine	46 μmol/L
AST	34 U/L
ALT	10 U/L
IgA	2.4 g/L
TSH	2.7 mIE/L
T4	13 pmol/L
IgE total	21 kU/l
IgE food panel fx5	<0,10 kU/l
Antitissue transglutaminase (IgA)	<7 U/ml
Celiac disease investigation	Negative

Table 2: Laboratory Test Results

As the patient demonstrated intense agitation and sugar cravings, an EEG was obtained and it showed a pathological activity with bilatero-temporal to central epileptiform activity was not synchronized.

Diagnosis

The patient was diagnosed with epilepsy.

Treatment

Lamotrigine therapy was initiated.

Clinical Outcome

Significant improvement was observed in agitation, moodiness and reduction of sugar craving with no change in concentration difficulties and hyperactivity.
Further therapy with CNS stimulants was considered.