Obesity Abstracts

Background: Seizures post-bariatric surgery are rarely reported yet are clinically significant. Severe postprandial hypoglycaemia can present as seizures in a patient with a history of bariatric surgery. However, differentiating between primary seizure disorders and hypoglycaemia-causing seizures can be challenging.

History: A 57-year-old female presented to our bariatric clinic with frequent seizures, occurring approximately three times per week. She underwent Roux-en-Y gastric bypass surgery in 2020. Her weight was 114 kg pre-surgery and is currently 88 kg. There were no symptoms suggestive of dumping syndrome.

Results: Blood tests, including micronutrients, electrolytes, and ammonia levels, were normal. We investigated her with a blinded continuous glucose monitoring (Dexcom G6) for ten days, during which time the patient was asked to complete a food and seizure diary. Over the ten-day period, the CGM recorded relatively stable glucose levels, indicated by moderate glucose variability with a coefficient of variation (CV) of 16% and an average glucose reading of 8.1 mmol/L. Hypoglycaemia was not detected, and during the three seizure episodes, glucose levels remained normal, ranging from 7.4 to 10.2 mmol/L.

Conclusions: The normal glucose levels observed during seizure episodes do not support a direct link to post-bariatric hypoglycaemia.

Learning points: Post-bariatric hypoglycaemia is an important differential diagnosis in patients presenting with new-onset seizures following gastric bypass surgery. Although CGM is not routinely used in obesity clinics, its utility in this case has been extremely useful in helping to exclude hypoglycaemia as the cause of the seizures.