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

Anthony Nguyen; Mohammad Ali Butt; Shubhra Upadhyay; Abu Baker Sheikh; Rahul Shekhar

doi:10.12890/2022_003179

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

Eur J Case Rep Intern Med. 2022 Feb 22;9(2):003179. doi: 10.12890/2022_003179. eCollection 2022.

Authors

Anthony Nguyen¹, Mohammad Ali Butt², Shubhra Upadhyay¹, Abu Baker Sheikh¹, Rahul Shekhar³

Affiliations

¹ University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA.
² Allegheny General Hospital, Department of Internal Medicine, Pittsburgh, PA, USA.
³ Division of Hospital Medicine, University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM, USA.

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.

Learning points: Non-convulsive status epilepticus (NCSE) is a rare complication of hepatic encephalopathy (HE).Clinical evaluation should be used to rule out different causes of altered mental status in patients with chronic liver disease.Consider EEG to diagnose NCSE in patients with suspected HE not responding to empiric treatment.

Keywords: Hepatic encephalopathy; electroencephalogram; non-convulsive status epilepticus.