Insulinoma misdiagnosed as intractable epilepsy
Bibliographic record
Abstract
Many conditions may mimic epileptic seizures, including movement disorders, cardiac arrhythmias, psychiatric disorders, or metabolic anomalies. Among these, insulinoma is a rare but curable cause of hypoglycemia often misdiagnosed as epilepsy or a psychiatric disorder. We report three patients with hypoglycemic spells caused by insulinoma. All patients were diagnosed during a video-EEG monitoring session initially performed for the evaluation of intractable epilepsy. ### Case 1. A 37-year-old woman had a 6-year history of stereotyped paroxysmal episodes of paresthesias of the left arm, spreading to the face and lower limbs, and lasting 20 minutes. Episodes could last up to 2 hours and included gait incoordination, mild agitation, emotional lability, and incoherent speech, which was followed by fatigue. Frequency of the attacks gradually increased up to twice a week. The patient was initially diagnosed with partial epilepsy, refractory to carbamazepine. No interictal activity was recorded during a prolonged video-EEG monitoring. Brain MRI was normal, and interictal SPECT revealed bifrontal and right posterior temporal hypoperfusion. A fasting blood glucose level was obtained and showed mild hypoglycemia at 3.2 mmol/L (normal, 3.8 to 6.1 mmol/L). …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".