Abstracts

Rationale:
Patients with pre-existing seizure risk factors such as intracranial lesions, strokes, or ICH receiving dialysis are at a higher risk of experiencing seizures. Dialysis disequilibrium syndrome (DDS) is a known entity which is a set of signs and symptoms associated with cerebral edema due to hemodialysis. Symptoms associated with the initial effects of cerebral edema caused by fluid shifts associated with dialysis can be missed in patients with neurological deficits.

Methods:
CASE 1: A 76 year old male with history of R MCA stroke within last three years started dialysis in 2012. Since starting dialysis, family noted episodes of being confused and less talkative with word finding difficulty. The patient had a GTC seizure during dialysis followed by another GTC after ED arrival. Lab findings upon admission were unremarkable for electrolyte abnormalities. He was started on Levetiracetam and has remained seizure free.

CASE 2: A 53 year old female with history of R MCA stroke >10 years ago, R SDH 3 years ago and post-stroke epilepsy that began 6 years ago started dialysis in September 2022 with increased in frequency of episodes provoked by dialysis.  

CASE 3: A 47 year old male with history of ESRD who started dialysis in 2018. Patient had a GTC seizure episodes 2 years after starting dialysis. Following epilepsy diagnosis, patient had breakthrough seizures associated with missed dose of medication and one admission for encephalopathy. He exhibited improvement in frequency of episodes from two to three per week to none after making changes in rate of fluid exchange during dialysis sessions.