Seizure Risk in an Adolescent Using Semaglutide: A Case Report
Abstract number :
3.125
Submission category :
18. Case Studies
Year :
2025
Submission ID :
127
Source :
www.aesnet.org
Presentation date :
12/8/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Madeline Lock, BS – University of Tennessee Health Science Center College of Medicine
Andrew Wilner, MD – University of Tennessee Health Science Center
Daniel Lee, BS – University of Tennessee Health Science Center
Nisa Syed, BS – University of Tennessee Health Science Center
Haewon Shin, MD – University of Tennessee Health Science Center. Department of Neurology. Memphis, TN.
Rationale: Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide (Wegovy), are increasingly used for obesity and type 2 diabetes management. Some studies suggest these new agents possess neuroprotective effects and reduce the risk of seizure. Hypoglycemia, a rare adverse effect of GLP-1 agonists, is usually observed in combination with insulin or sulfonylureas. However, the risk of subclinical hypoglycemia potentially triggering seizures in predisposed individuals has not been adequately evaluated. This case report investigates the potential relationship between semaglutide use and new-onset seizure activity in an adolescent.
Methods: An 18-year-old female with obesity, prediabetes, and anxiety experienced a witnessed first-time seizure while driving. She had been using semaglutide (Wegovy) for six months and lost 88 pounds. Previously, she had experienced multiple episodes of lightheadedness attributed to hypoglycemia. Her mother and cousin have epilepsy. After the car accident, the patient had a second witnessed convulsion. Examination in the ER revealed left-sided neglect, left gaze deviation, and an altered mental state. She was intubated and treated with 3000 mg levetiracetam (Keppra). She regained consciousness after two hours and was extubated with no memory of the event. Initial labs revealed severe lactic acidosis (lactate 16, pH 6.9, anion gap 31) and leukocytosis (WBC 17.7) Electrolytes, including sodium and calcium, were within normal limits. Serum glucose levels ranged from 73–86 mg/dL. Urine drug screen was positive for marijuana. Neurological examination, EKG, EEG, and MRI were normal.
Results: Although no hypoglycemia was documented, the patient's history of lightheadedness coupled with significant weight loss on semaglutide suggests subclinical hypoglycemia as a possible precipitant of her seizures. Additional seizure risk factors included a family history of epilepsy and escitalopram, an SSRI that can lower the seizure threshold. The patient remained seizure-free during hospitalization, was discharged on levetiracetam, and instructed to consider lowering her semaglutide dosage. At her 6 week follow up, the patient reported no recurrent seizures. She had reduced her semaglutide dose from 2.4 mg to 1 mg weekly and continued taking levetiracetam 1500 mg twice daily. She will continue at her current dose and return to clinic in 3 months
Conclusions: This case suggests that GLP-1 agonists like semaglutide, which may induce hypoglycemia, particularly when combined with additional factors such as a family history of epilepsy and the use of medications like escitalopram, may contribute to the risk of seizures. Healthcare providers should consider recent weight loss and GLP-1 agonist use as possible contributing factors when evaluating new-onset seizures. Further research is needed to better understand the potential effects of GLP-1 agonists in precipitating seizures.
Funding: UTHSC Department of Neurology
Case Studies