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Epileptiform abnormalities in hepatic encephalopathy

D M Ficker1, B F Westmoreland, F W Sharbrough

  • 1Mayo Clinic Department of Neurology, Rochester, Minnesota, USA.

Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
|May 1, 1997
PubMed
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Epileptiform abnormalities, such as seizures, are uncommon in hepatic encephalopathy patients. When present, these EEG findings indicate a poor prognosis and often lack a clear cause on neuroimaging.

Area of Science:

  • Neurology
  • Gastroenterology

Background:

  • Hepatic encephalopathy (HE) is a complex neuropsychiatric complication of liver dysfunction.
  • Epileptiform abnormalities on electroencephalogram (EEG) are considered rare in HE patients.

Purpose of the Study:

  • To investigate the prevalence and characteristics of epileptiform abnormalities in patients with hepatic encephalopathy.
  • To determine the prognostic significance of epileptiform discharges in this patient population.

Main Methods:

  • Retrospective review of EEG data from patients diagnosed with hepatic encephalopathy over a 10-year period.
  • Analysis of epileptiform discharge types, seizure activity, and neuroimaging findings.
  • Correlation of EEG findings with patient outcomes, including mortality and clinical deterioration.

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Main Results:

  • Epileptiform abnormalities were identified in 15% (18/120) of HE patients reviewed.
  • Interictal discharges (focal, bilateral independent, generalized) and electrographic seizures were observed.
  • Clinical seizures occurred in 12 patients; neuroimaging often failed to reveal the etiology of epileptiform discharges.

Conclusions:

  • Epileptiform abnormalities can occur in hepatic encephalopathy, though infrequently.
  • The presence of epileptiform discharges in HE patients is associated with a poor prognosis.
  • Further research is needed to elucidate the mechanisms underlying epileptiform activity in HE.