Background: As a neuroactive steroid, vitamin D is essential for optimal neuronal functioning1. Its immunomodulatory and neuroprotective effects aid in reduction of proconvulsant cytokines, membrane excitability and seizure prevention2-3. Deficiency plays an important role in neurological and psychiatric illnesses, though clinical manifestation with seizures and psychosis have not been described. Methods: A 61-year-old female presented with 3-day history of confusion, insomnia and new onset seizure. She was noted to have poor dentition, deformed nail bed and multiple ecchymosis. Neurologically, there were brisk reflexes with some spread. She worsened with frequent seizures and psychosis. Results: Laboratory investigation showed serum Vitamin D level of 19nmol/L, hemoglobin of 70g/L. MRI head revealed T2 hyperintensities in bilateral anterolateral temporal lobes and EEG consistent with bitemporal lobe epilepsy. Autoimmune and infectious work up were negative. Treatment with antipsychotics, several antiepileptics, high dose Vitamin-D and iron supplements were initiated. Initially, she remained unresponsive to neuro/psych medications. Improvement in clinical symptoms was noticed in 4th week of admission, with complete resolution of MRI, EEG findings. Conclusions: Evidence surrounding hypovitaminosis D and risk on the central nervous system continues to grow. This case highlights the significance of vitamin-D on brain processes and its neurological manifestations in state of deficiency.

1. Kalueff.A.,2006. 2. Garcion. E, 2003. 3. Eyles, D., 2013.