A 27-year-old man kept having seizures even though he was taking multiple seizure medications. Doctors discovered his body wasn’t controlling calcium levels properly—a rare condition called hypoparathyroidism. Surprisingly, two of his seizure medications were actually making the calcium problem worse by speeding up how his body breaks down vitamin D. Once doctors gave him calcium through an IV and switched his medications, his seizures stopped within a day. This case teaches doctors to look for hidden body chemistry problems when seizure medicines aren’t working as expected.

The Quick Take

  • What they studied: Why a young man’s seizures kept happening even though he was taking strong seizure medications, and what doctors discovered was actually causing the problem.
  • Who participated: One 27-year-old man with a known seizure disorder who came to the emergency room having multiple seizures every day that weren’t responding to his medications.
  • Key finding: The patient had dangerously low calcium levels caused by a rare gland problem (hypoparathyroidism). Two of his seizure medications were making this worse by breaking down his vitamin D faster, which made his calcium drop even lower.
  • What it means for you: If someone’s seizures suddenly get worse despite taking seizure medications, doctors should check for hidden problems with body chemistry like calcium levels. This is especially important before adding more medications. However, this is a very rare condition, so it wouldn’t apply to most people with seizures.

The Research Details

This is a case report, which means doctors are describing what happened with one specific patient in detail. The 27-year-old man came to the emergency room having seizures multiple times a day. Doctors did blood tests and found his calcium was extremely low and his phosphate was very high. They also did a CT scan of his brain and found calcium deposits in a part of the brain called the basal ganglia. The doctors realized that two seizure medications he recently started—phenytoin and carbamazepine—were speeding up how his body breaks down vitamin D, which made his calcium problem even worse.

Case reports are important because they describe unusual situations that doctors might not think about. This case is valuable because it shows that sometimes seizure medications themselves can cause problems if a patient has an underlying condition. It reminds doctors to think about what might be causing seizures to get worse, not just to add more medications.

This is a single case report, so it describes one person’s experience rather than testing many people. While case reports can’t prove something works for everyone, they’re useful for alerting doctors to rare but important possibilities. The doctors did thorough testing and clearly documented what they found, which makes this report reliable for describing this particular situation.

What the Results Show

The patient had severe hypocalcemia, which means his blood calcium was dangerously low. His parathyroid hormone (a chemical that controls calcium) was also very low, which pointed to a problem with his parathyroid glands. The CT scan showed calcium deposits in his brain’s basal ganglia, a pattern called Fahr’s syndrome that sometimes goes with this gland problem. When doctors checked his physical exam, they found two special signs—Trousseau’s sign and Chvostek’s sign—that indicate low calcium. The key discovery was that his seizure medications were making everything worse. Phenytoin and carbamazepine are powerful medications that speed up how the body breaks down vitamin D. Since vitamin D helps the body absorb and use calcium, breaking it down faster made his calcium drop even lower, which made his seizures worse.

The patient also had high phosphate levels, which goes along with low calcium and low parathyroid hormone. These three findings together clearly pointed to primary hypoparathyroidism—a rare condition where the parathyroid glands don’t work properly. The brain calcifications (Fahr’s syndrome) suggested this condition had been present for a while, even though it wasn’t diagnosed until now.

Hypoparathyroidism is known to cause seizures because low calcium makes the nervous system overactive. However, this case is unusual because the seizures got much worse after starting seizure medications. Most doctors wouldn’t expect seizure medications to make seizures worse, so this case highlights an important but rare interaction. Previous research has shown that some seizure medications can affect vitamin D metabolism, but this case shows how serious that effect can be in patients with underlying gland problems.

This is only one patient’s story, so we can’t know how often this happens or if it would work the same way for other people. The patient may have had other factors we don’t know about. Also, we don’t know what happened to this patient after he left the hospital or if his seizures stayed controlled long-term. Case reports are good for spotting unusual situations but can’t prove something happens the same way for everyone.

The Bottom Line

If someone has seizures that suddenly get worse despite taking seizure medications, doctors should check for hidden problems with body chemistry, especially calcium and vitamin D levels. This is particularly important before adding more seizure medications. However, this is a very rare cause of worsening seizures, so most people with seizures won’t have this problem. If someone does have this condition, switching to seizure medications that don’t speed up vitamin D breakdown (like levetiracetam in this case) and giving calcium supplements can help.

This finding is most important for emergency room doctors and neurologists (brain specialists) who treat patients with seizures that aren’t responding to medications. It’s also relevant for people with a family history of parathyroid problems or those who have seizures that suddenly get worse. Most people with well-controlled seizures don’t need to worry about this rare condition.

In this case, calcium levels returned to normal within 24 hours of receiving calcium through an IV, and seizures stopped immediately. However, this is one patient’s experience, and recovery time might be different for other people.

Want to Apply This Research?

  • If you take seizure medications, track the frequency of seizures weekly and note any changes after medication adjustments. Also track any symptoms of low calcium like muscle twitching, tingling in fingers, or numbness.
  • Work with your doctor to get regular blood tests checking calcium and vitamin D levels, especially if your seizures change or if you start new seizure medications. Keep a detailed log of when seizures happen and what medications you’re taking.
  • Set monthly reminders to review seizure frequency trends and calcium-related symptoms. If you notice seizures getting worse despite taking medications as prescribed, contact your doctor immediately rather than waiting for your next scheduled visit.

This case report describes one patient’s experience with a very rare condition. It is not medical advice and should not be used to diagnose or treat any condition. If you or someone you know has seizures that are not responding to medications, please consult with a neurologist or emergency medicine doctor immediately. Do not change seizure medications without talking to your doctor first. While this case highlights the importance of checking for underlying metabolic problems, most people with worsening seizures have other causes. Always seek professional medical evaluation for seizure-related concerns.