Abstracts

Chromium picolinate is popular dietary supplement for weight reduction. We experienced a case of reversible partial seizure and limbic encephalopathy, worth attention in medical communities. A 59 year old veteran visited our outpatient neurology clinic for intermittent episodes of deja vu, gasoline smell, and rage attack. The symptom started since he started ingesting dietary chromium picolinate pills at least once a day since five years ago. The patient has never experienced clinical seizure spells and had no previous history of seizure disorder. Neurological examination and brain MRI study were normal. Serial EEG studies were done. Initial EEG study demonstrated frequent interictal sharp discharges (IID) in the bilateral inferior temporal electrodes (T1 and T2) independently, but more preponderent in the left as a few spikes per page. The background activity was consistent with 10Hz alpha activity. Hyperventilation induced a single isolated high amplitude epileptiform discharge with maximum negativity at T3. Decision was made not to start anticonvulsant but to discontinue habitual use of chromium picolinate. In the subsequent clinical follow up, the patient reported no recurrence of olfactory aura, deja vu, and mood swings. The EEG in 3 month showed decreased number of IID in left temporal electrodes at T1 and T3 but much less in frequency as one spike per 20 pages. The EEG in 6 month was negative in IIDs. A case of reversible partial seizure due to chromium picolinate is described. The EEG findings were not only suggestive of the secondary epileptogenesis with bilateral independent discharges, but also indicative of reversible recovery process which was gradual after discontinuation of chromium picolinate. This supplemental form of organic chromium has been used as an active ingredient for weight reduction pills and diet beverages. Although its underlying pathophysiological mechanism has not been studied, chronic use of chromium picolinate should be counted and ruled out as a cause of new onset of reversible limbic encephalopathy in our modern community.