FULMINANT HEPATIC-FAILURE ASSOCIATED WITH STATUS EPILEPTICUS IN CHILDREN - 3 CASES AND A REVIEW OF POTENTIAL MECHANISMS

Fulminant hepatic failure is a rare complication of status epilepticus . Although many of the anticonvulsants used to treat the seizures are known to have hepatotoxic properties, the exact mechanism leading to m assive destruction of the liver following a prolonged seizure remains unclear. Three children are presented who developed fulminant hepatic failure following status epilepticus and subsequently died of multiple organ failure. The literature is reviewed with particular attention t o the possible interaction between the anticonvulsants and the metabol ic consequences of status epilepticus. We postulate that it is a combi nation of hypoxia and ischemia that occurs during a prolonged seizure with altered metabolism of free radicals secondary to the anticonvulsa nt drugs which leads to widespread hepatocyte membrane damage.