Abstract
We can find several reports on epileptic convulsion observed in the course of anorexia nervosa and bulimia nervosa, but the mechanism of this convulsion is not clear. A case of a 25-year-old bulimic female revealing grand-mal seizure due to hypoglycemia after selfinduced vomiting is presented. Initially, her eating disorder began at age 18 as indicating typical figure of anorexia nervosa, then turned to bulimia nervosa (DSM-III-R) with self-induced vomiting. She was admitted to our hospital on April 1991 because of worsening of her eating behavior and emaciation (152 cm, 28 kg) . During admission her bodyweight recovered up to 39 kg by psychotherapy and drip infusion of glucose. One evening in September 1991,she lost her consciousness and had generalized tonic-clonic seizures after self-induced vomiting following binge eating. At that time, her blood glucose level was 46 mg/dl, and she was awaked soon after 20 ml injection of 40% glucose. It was considered that the cause of her convulsion was due to hypoglycemia, thus the patient was asked the following day to perform the same eating behavior as the day before and traced the blood glucose, IRI, IRG, cortisol, GH, adrenalin, and noradrenalin level during binge eating and after vomiting. Serum IRI Ievel after binge eating was higher than expected as compared to the blood glucose level, and reactive hypoglycemia was observed after self-induced vomiting. No responses of counter regulatory hormones was detected. Her EEG showed intermittent 5-7 Hz θ-wave on a slow background frequency. The CT scan of her brain indicated normal. She complained prolonged headache until next morning after hypoglycemic attack. This is the first case report that indicated the correlation between the convulsion seen in bulimia nervosa and the reactive hypoglycemia after binge eating followed by self-induced vomiting.
