Non-Convulsive Status Epilepticus in Hepatic Encephalopathy: A Case Series and Review of the Literature

  • Anthony Nguyen University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA
  • Muhammad Ali Butt Allegheny General Hospital, Department of Internal Medicine, Pittsburgh, PA, USA
  • Shubhra Upadhyay University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA
  • Abu Baker Sheikh University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA
  • Rahul Shekhar Division of Hospital Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA

Keywords

Hepatic encephalopathy, non-convulsive status epilepticus, electroencephalogram

Abstract

Hepatic encephalopathy is a common complication in chronic liver disease and cirrhosis. Here we describe two patients with hepatic encephalopathy who did not respond to standard empiric treatment and were found to have non-convulsive status epilepticus. Both patients improved with antiepileptic therapy. Non-convulsive status epilepticus should be considered in the differential diagnosis of patients with suspected hepatic encephalopathy who do not respond to empiric treatment.

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References

  • Centers for Disease Control and Prevention. FastStats - Chronic Liver Disease or Cirrhosis. Available from: https://www.cdc.gov/nchs/fastats/liver-disease.htm (accessed 14 August 2021).
  • Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther 2007;25(Suppl. 1):3–9. doi: 10.1111/j.1746-6342.2006.03215.x.
  • Bajaj JS, O’Leary JG, Tandon P, Wong F, Garcia-Tsao G, Kamath PS, et al. Hepatic encephalopathy is associated with mortality in patients with cirrhosis independent of other extrahepatic organ failures. Clin Gastroenterol Hepatol 2017;15(4):565–574.e4. doi: 10.1016/j.cgh.2016.09.157.
  • Ferenci P. Hepatic encephalopathy in adults: clinical manifestations and diagnosis. UpToDate. Available from: https://www.uptodate.com/contents/hepatic-encephalopathy-in-adults-clinical-manifestations-and-diagnosis (accessed 14 August 2021).
  • Kaplan PW. The clinical features, diagnosis, and prognosis of nonconvulsive status epilepticus. Neurologist 2005;11(6):348–361. doi: 10.1097/01.nrl.0000162954.76053.d2.
  • Rudler M, Marois C, Weiss N, Thabut D, Navarro V, Brain-Liver Pitié-Salpêtrière Study Group (BLIPS). Status epilepticus in patients with cirrhosis: how to avoid misdiagnosis in patients with hepatic encephalopathy. Seizure 2017;45:192–197. doi: 10.1016/j.seizure.2016.12.011.
  • Donovan JP, Schafer DF, Shaw BW, Sorrell MF. Cerebral oedema and increased intracranial pressure in chronic liver disease. Lancet 1998;351(9104):719–721. doi: 10.1016/S0140-6736(97)07373-X.
  • Elwir S, Rahimi RS. Hepatic encephalopathy: an update on the pathophysiology and therapeutic options. J Clin Transl Hepatol 2017;5(2):142–151. doi: 10.14218/JCTH.2016.00069.
  • Richardson AJ, McKain N, Wallace RJ. Ammonia production by human faecal bacteria, and the enumeration, isolation and characterization of bacteria capable of growth on peptides and amino acids. BMC Microbiol 2013;13(1):6. doi: 10.1186/1471-2180-13-6.
  • Wijdicks EFM. Hepatic encephalopathy. N Engl J Med 2016;375(17):1660–1670. doi: 10.1056/NEJMra1600561.
  • Gerber T, Schomerus H. Hepatic encephalopathy in liver cirrhosis: pathogenesis, diagnosis and management. Drugs 2000;60(6):1353–1370. doi: 10.2165/00003495-200060060-00008.
  • Tapper EB, Jiang ZG, Patwardhan VR. Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy. Mayo Clin Proc 2015;90(5):646–658. doi: 10.1016/j.mayocp.2015.03.003.
  • Ficker DM, Westmoreland BF, Sharbrough FW. Epileptiform abnormalities in hepatic encephalopathy. J Clin Neurophysiol 1997;14(3):230–234. doi: 10.1097/00004691-199705000-00008.
  • Gursky JM, Rossi KC, Jetté N, Dhamoon MS. Exacerbation of hepatic cirrhosis may trigger admission for epilepsy and status epilepticus. Epilepsia 2020;61(3):400–407. doi: 10.1111/epi.16437.
  • Hor S, Chen CY, Tsai ST. Propofol pump controls nonconvulsive status epilepticus in a hepatic encephalopathy patient: a case report. World J Clin Cases 2019;7(18):2831–2837. doi: 10.12998/wjcc.v7.i18.2831.
  • Jhun P, Kim H. Nonconvulsive status epilepticus in hepatic encephalopathy. West J Emerg Med 2011;12(4):372–374. doi: 10.5811/westjem.2011.1.2125.
  • Jo YM, Lee SW, Han SY, Baek YH, Ahn JH, Choi WJ, et al. Nonconvulsive status epilepticus disguising as hepatic encephalopathy. World J Gastroenterol 2015;21(16):5105–5109. doi: 10.3748/wjg.v21.i16.5105.
  • Badshah MB, Riaz H, Aslam S, Badshah MB, Korsten MA, Munir MB. Complex partial non-convulsive status epilepticus masquerading as hepatic encephalopathy: a case report. J Med Case Rep 2012;6(1):2–4. doi: 10.1186/1752-1947-6-422.
  • Published: 2022-02-22

    Issue: 2022: Vol 9 No 2 (view)

    Section: Articles

    How to cite:
    1.
    Nguyen A, Butt MA, Upadhyay S, Sheikh AB, Shekhar R. Non-Convulsive Status Epilepticus in Hepatic Encephalopathy: A Case Series and Review of the Literature. EJCRIM 2022;9 doi:10.12890/2022_003179.