# Focal Seizures in a Patient With Chronic Basal Ganglia Calcifications Secondary to Idiopathic Primary Hypoparathyroidism

## TL;DR

A man with long-term hypoparathyroidism and brain calcifications developed focal seizures, highlighting the need for more awareness of this rare condition.

## Contribution

This case report adds to the limited literature on focal seizures associated with basal ganglia calcifications from hypoparathyroidism.

## Key findings

- A 65-year-old man with hypoparathyroidism and BGC developed focal seizures after 30 years.
- Seizures were controlled with levetiracetam despite stable brain calcifications and normal lab values.
- The case emphasizes the importance of recognizing rare neurological complications of hypoparathyroidism.

## Abstract

Patients with hypoparathyroidism can present with concurrent basal ganglia calcifications (BGCs). The exact pathogenesis is unknown, although it is thought to relate to calcium-phosphate deposition from chronic hypocalcemia and hyperphosphatemia. We present the case of a 65-year-old man with known idiopathic primary hypoparathyroidism and concurrent extensive BGC. Thirty years after diagnosis, he presented with focal seizures despite a decade of stable intracranial calcifications on imaging. Serum calcium, phosphate, 25-hydroxyvitamin D, and parathyroid hormone levels were well controlled during this period. He was commenced on lifelong levetiracetam with subsequent seizure remission. Given the scarcity of literature surrounding focal seizures and BGC, it is essential to raise awareness in this area.