Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments

Graphical abstract
Sherifa A. Hamed, Samir K. Abdulhamid, Ali F. Elhadad



Background and objectives: Recurrent seizures are a consequence of uremia due to chronic kidney disease (CKD). This study was aimed to determine types, frequencies, causes and treatments of uremic seizures and their independent predictors.

Methods:Seventy adults (male = 33; female = 37) were included. They had mean age of 45.87 ± 3.36 years and duration of kidney failure (stage 3-5) of 5.53 ± 1.53 years. They underwent clinical and laboratory investigations and electroencephalography (EEG) and brain neuroimaging.

Results: Eleven patients (15.7%; on dialysis = 6, not on dialysis = 5) developed recurrent seizures after the development of CKD. Six had (54.55%) generalized tonic-clonic (GTC) seizures, of them 4 (66.67%) had tetany, hypocalcemia (< 6 mg/dl), hyperparathyroidism and brain calcifications. Five (45.45%) had focal to bilateral GTC seizures, focal electroencephalography (EEG) epileptic discharges and white matter ischemic hyperintensities in their brain magnetic resonance imaging. Epileptic EEG discharges (spikes and spike-wave complexes) were found in 24.3% (n = 17) in absence of seizures. Compared to those without seizures, the majority of patients with seizures had end stage kidney disease (ESKD), metabolic derangements and neuroimaging abnormalities. Multiple regression analysis showed that the presence of uremic seizures was independently correlated to the severity of kidney failure (OR = 1.25, 95% Cl = 1.08-1.30, P = 0.01) and metabolic derangements (OR = 2.44; 95% CI = 1.25-2.80, P = 0.01).

Conclusion: Recurrent seizures are common with uremia. The progression of uremia and its acute manifestations (as uremic encephalopathy with/of without metabolic derangements) were the most common precipitating factors for uremic seizures. Improvements of seizures occurred with hemodialysis and correction of metabolic derangements.

Published on: January 4, 2021
doi: 10.17756/jnen.2021-080
Citation: Hamed SA, Abdulhamid SK, Elhadad AF. 2020. Uremic Seizures with Chronic Kidney Disease: Clinical Types, Possible Mechanisms and Response to Treatments. J Neurol Exp Neurosci 7(1): 1-8.