Background Patients with hypoparathyroidism always present with recurrent tetany caused by hypocalcemia. These patients are usually misdiagnosed as epilepsy and incorrectly treated with anti-epileptic drugs.
Objective To analyze the clinical data about 22 patients with hypoparathyroidism misdiagnosed as epilepsy and summarize the clinical experience for reducing misdiagnosis and mistreatment about hypoparathyroidism.
Methods Totally 160 patients with hypoparathyroidism who were administrated to the First Medical Center of Chinese PLA General Hospital from January 1, 2008 to July 1, 2021 were enrolled in this report. Clinical about 22 patients initially misdiagnosed with epilepsy were analyzed.
Results Of the 160 cases with hypoparathyroidism, 22 patients (12 males and 10 females) were misdiagnosed with epilepsy in local hospitals. The misdiagnosis rate was 13.75% and the median duration of misdiagnosis was 8.0 (IQR: 2.0, 14.8) years. The clinical manifestations of the 22 patients misdiagnosed as epilepsy included tetany in 18 cases (81.8%), disturbance of consciousness in 6 cases (27.3%), limb numbness in 3 cases (13.6%), limb weakness in 6 cases (27.3%), mental and behavioral abnormality in 2 cases (9.1%), and memory impairment in 3 cases (13.6%), etc. Electroencephalogram (EEG) was performed in 9 cases, which presented as slow wave and spike-slow complex wave in 3 cases, slowing down of θ and δ band background in 2 cases and normal EEG in 4 cases. Fifteen cases underwent head computed tomography (CT) scan, in which 13 cases had intracranial calcification. All patients were treated with anti-epileptic drugs, of which 17 patients were treated with two kinds of drugs. After diagnosis, anti-epileptic drugs were gradually reduced and withdrawn after calcium and calcitriol treatment in 17 cases. In the other 5 cases with secondary epilepsy, the anti-epileptic drugs was reduced to one type and their clinical condition improved obviously.
Conclusion The clinical manifestations of hypoparathyroidism are complex and usually misdiagnosed as primary epilepsy. Detection of serum calcium, phosphorus and parathyroid hormone is very important to avoid misdiagnosis and mistreatment about hypoparathyroidism.
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