Patel Siddharth, Faust Taylor, Chimakurthy Anil, Pathak Prutha, Antony Mc Anto, Thiriveedi Mrudula, Baddam Sujatha
Decatur Morgan Hospital, Decatur, AL, USA.
Alabama College of Osteopathic Medicine, Dothan, AL, USA.
Ann Med Surg (Lond). 2025 May 26;87(7):4602-4607. doi: 10.1097/MS9.0000000000003406. eCollection 2025 Jul.
Vitamin B6 (pyridoxine) deficiency is a rare but reversible cause of seizures in adults, which is often overlooked in post gastrectomy patients. This case highlights the critical role of nutritional supplementation in preventing severe complications such as neuropsychiatric manifestations and seizures, emphasizing the importance of vigilance in postoperative care and patient follow-up.
A 46-year-old woman with a history of partial gastrectomy presented with intermittent confusion and somnolence for a duration of 6 months. Physical exam revealed temporal wasting, dry skin, and a low BMI. Laboratory tests showed undetectable levels of vitamin B6, while an electroencephalogram (EEG) demonstrated electrographic status epilepticus. Despite antiepileptic therapy the patient's symptoms continued until high dose intravenous vitamin B6 was administered, leading to rapid improvement clinically and on EEG. The patient was discharged on oral pyridoxine and multivitamins, remaining seizure-free including at her 6-month follow-up.
This case illustrates the rare occurrence of adult-onset seizures due to vitamin B6 deficiency, following gastric surgery. A thorough literature review shows a link between pyridoxine deficiency and seizures, specifically in the context of malnutrition or chronic health conditions. This case underscores a need for routine preoperative and postoperative nutritional assessments, including micronutrient level monitoring in order to mitigate these risks.
This case illustrates an extremely rare but preventable clinical syndrome of vitamin B6 deficiency and re-emphasizes the role of nutritional supplementation after gastrectomy. Prompt recognition and treatment of this condition are essential, highlighting the critical role of comprehensive nutritional care and postoperative management of gastrectomy patients.
维生素B6（吡哆醇）缺乏是成人癫痫发作的一种罕见但可逆转的病因，在胃切除术后患者中常常被忽视。本病例强调了营养补充在预防诸如神经精神表现和癫痫发作等严重并发症方面的关键作用，突出了术后护理和患者随访中保持警惕的重要性。
一名有部分胃切除术病史的46岁女性出现间歇性意识模糊和嗜睡6个月。体格检查发现颞部消瘦、皮肤干燥且体重指数较低。实验室检查显示维生素B6水平检测不到，而脑电图（EEG）显示为癫痫持续状态。尽管进行了抗癫痫治疗，但患者症状持续，直到给予高剂量静脉注射维生素B6后，临床症状和脑电图均迅速改善。患者出院时服用口服吡哆醇和多种维生素，包括在6个月随访时均无癫痫发作。
本病例说明了胃手术后因维生素B6缺乏导致成人癫痫发作的罕见情况。全面的文献综述显示吡哆醇缺乏与癫痫发作之间存在关联，特别是在营养不良或慢性健康状况的背景下。本病例强调需要进行常规的术前和术后营养评估，包括微量营养素水平监测，以降低这些风险。
本病例说明了一种极其罕见但可预防的维生素B6缺乏临床综合征，并再次强调了胃切除术后营养补充的作用。及时识别和治疗这种情况至关重要，突出了胃切除术后患者全面营养护理和管理的关键作用。
