Seizures

Question
QUESTION: I had laparoscopic gastric bypass surgery in June 2011. Followed all requirements, i.e. vitamins, meals and exercise - lost over 100lbs. I felt great until May of 2012 when I passed out while shopping. Was taken to the hospital - woke up in the ER. Had critically low potassium 2.8. They kept me overnight and replaced via IV. Diagnosed as syncope. Continued on until Sept 2012 when I had a seizure while at a football game - taken to the hospital again - woke up in the ambulance. My blood sugar was 59 and potassium again critically low at 2.9. They gave me potassium supplements and keppra and sent me home. Couldn't drive anymore until seizure free for 3 mons. CT scan, MRI and EEG all normal. Neurologist says I don't have epilepsy. Waiting on 3 day EEG before being taken off keppra.  Had another seizure Oct 22. Woke up in ambulance. Potassium 3.4. No one seems to know what's causing the seizures. Any ideas? I'm thinking it's hypoglycemia. Am seriously thinking of revision surgery.

ANSWER: Carole,
You are describing a really difficult situation; I hope I can help. You mentioned low blood sugar as a possible cause of seizures and I agree that's a possibility. I would imagine that, if low blood sugar is the culprit, you would be having multiple episodes of low sugar; do you have symptoms of low sugar with regularity?  (typical symptoms would be a feeling of weakness, trembling, heart racing, sweating).  Also, have you measured episodes of low sugar besides the ones that you mentioned?

Looking at a separate angle on this question, have you been seen by your Bariatric surgeon or anyone experienced in Bariatric surgery?  I would be interested in having your vitamin levels checked since some (such as thiamine) are related to nerve/brain health.

A couple of your seizure episodes were associated with low potassium. I don't normally think of low potassium with seizures but it could go with abnormalities of sodium levels and that certainly can be associated with seizures. Has anyone figures out why your potassium kept going down?  I ask because the cause of the low potassium could also disrupt the other blood chemistries and correction of that problem might eliminate the seizures.

Best of luck!
Dr JP

---------- FOLLOW-UP ----------

QUESTION: I've had numerous blood tests. I just did many more on the 16th for the neurologist. I don't have the results yet. I've been taking all my vitamins and supplements religiously. The first two episodes - I didn't eat when I should have. The first time I just blacked out and hit my head pretty bad. The second and third episodes were definitely more seizure like. I had palpitations with all three. I also wore a holter monitor - all results were normal. Before the first episode - I had the stomach flu really bad two days before. They assumed I lost my potassium from that but yet 4 months later my potassium was just as low again with no intestinal issues. I've been on potassium supplements since and was tested on the 12th with a normal 4.5 yet by the 22nd it was down to 3.4. I've read online that if you have a lot of insulin, your potassium can be depleted which is why I'm thinking of the reactive hypoglycemia. I know that my thiamine level was just checked but I don't know the results yet. My surgeon has not been interested in seeing me sooner than my 18 month check up in Dec. She just sent a text message saying the seizure was not a result of my surgery and that I should see a neurologist. All of my other electrolyte levels are in the normal range. My fasting glucose tests are always in the normal range. Whenever I have an episode - my glucose is either really low or really high. The second episode - they gave me liquid glucose in the ambulance. My heart rate is usually sky high 120 plus when my resting heart rate is 50-60 range. I was really active before this - running 4 miles a day, working with a personal trainer 2 hours a week. Now I don't dare to do anything because they don't know what's causing my seizures. My weight has dropped 5lbs in 6 weeks and I haven't done a thing! My general doctor doesn't know what's causing my problems and the neurologist can't figure it out either (although he thinks it's tied to the potassium). What am I to do?

Answer
Carole,
I would not try to diagnose from a distance but it sounds like the potassium deficiency is at least a part of the problem. It's true that insulin variations can cause potassium levels to fluctuate as potassium moves in and out of cells, but that type of fluctuation does not in my experience lead to the very low levels you described. Things would make more sense if there is a cause of potassium loss; the most common causes are loose bowlels/diarrhea, or intake if diuretic meds that cause potassium loss through the kidneys.

I regret that your Bariatric surgeon is not interested in this situation; perhaps you can see a GI doctor in your area since the gastric bypass is probably tied into this in some way.

Dr JP

1. Prev:Bariatric Surgery with Crohns Disease
2. Next:3 years post op gastric bypass with gain