Hypocalcemic Partial Seizures in the Newborn

Background: Presentation of a male infant aged 37 days. Parents reported “twitching” of the right side of the body. We saw clonic seizures of one hemisphere changing sides in the course of the first day. Exclusively breast-fed, 6th child of immigrants from Syria, received standard prophylaxis of phytomenadione and cholecalciferol.

Methods: Normal cranial MRI, EEG showed discrete global dysfunction with sparse spikes left and right interictally, then clinically right-sided hemiseizure with rhythmic spikes on the left side. Laboratory results showed reduced ionized serum calcium, elevated levels of phosphate and parathyroid hormone, calcifediol below detection threshold. Lumbar puncture and other metabolic parameters were normal.

Results: After parenteral substitution of calcium gluconate, the seizures immediately disappeared. When we changed to oral substitution, we saw one more decline of ionized serum calcium to 0.9 mmol/L and one last partial seizure. In our patient’s mother, we found similar laboratory results with reduced calcifediol and elevated phosphate and parathyroid hormone. Thus, we diagnosed connatal hypocalcemia due to maternal deficit of calcifediol.

Conclusion: There are two remarkable aspects: partial seizures in a systemic problem such as hypocalcemia, although this correlation was suggested by the change of sides as we know from other bilateral epileptic syndromes of infancy. Furthermore, people with dark skin tend to lack sunlight-dependent conversion of provitamin D. Our patient’s mother also wears a headscarf, reducing skin exposure to the sun even further. We suggest to consider this important, well-treatable differential diagnosis in young infants with seizures of all forms.