Focal neurologic deficits on 19 occasions in seven children with diabetes are reported from Children’s Hospital, Winnipeg, Manitoba, Canada. None had a history of a seizure disorder or a febrile seizure prior to onset of diabetes. One had generalized seizures attributed to hypoglycemia. Two had a parent with migraine. The neurological examination was normal between events, all of which occurred during sleep. All seven patients had at least one episode of a focal motor deficit. Two children had separate episodes of right and left-sided hemiparesis, two had focal motor seizures followed by ipsilateral paresis, and two had headache beginning after the onset of the acute neurologic event. Hypoglycemia was demonstrated on the three occasions that blood glucose was measured at the outset of hemiparesis or focal seizures. 
COMMENT. The authors consider that focal seizures induced by hypoglycemia are the most likely cause of these transient neurologic deficits and that the paretic episodes are examples of Todd paralysis. The administration of sugar did not always result in reversal of the neurologic deficit and the neurological symptoms were not a direct consequence of hypoglycemia. Hemiplegic migraine seemed to be an unlikely explanation. The anticonvulsant phenytoin has a hyperglycemic effect  and may be beneficial in the treatment of seizures and transient hemiparesis associated with hypoglycemia in diabetic children.