EPILEPTIFORM ABNORMALITIES IN HEPATIC-ENCEPHALOPATHY

Epileptiform abnormalities are uncommon in patients with hepatic encep halopathy. A review of EEGs in patients with hepatic encephalopathy ov er a 10-year period identified 18 (15%) with epileptiform abnormalitie s. Thirteen patients had interictal discharges consisting of focal spi ke and sharp wave discharges, bilateral independent discharges, and ge neralized spike and wave discharges. A total of 10 patients had electr ographic seizure discharges, focal in 6 and generalized in 5 (some pat ients had more than one abnormality). Twelve patients had clinical sei zures, partial in four and generalized in eight. Neuroimaging failed t o provide an etiology for the generation of epileptiform discharges in most patients, including those with focal abnormalities. Most patient s with epileptiform discharges died or deteriorated. We conclude that epileptiform can be seen in patients with hepatic encephalopathy, and when present imply a poor prognosis.