Fulminant Hepatitis After Grand Mal Seizures: Mechanisms and Role of Liver Transplantation

Abstract

Fulminant liver failure is a rare complication of grand mal seizures with a high mortality, the prognosis being largely determined by the combination of the hepatic and neurologic insults. The mechanisms of acute liver failure secondary to grand mal epilepsy and the place of liver transplantation in this context are poorly defined and are the subject of this report. A series of 6 such patients is presented. All had a history of chronic primary or post-traumatic epilepsy and presented with acute liver failure shortly after a grand mal fit. Detailed accounts of background, presentation, and management are given and integrated with blood, radiologic, and histologic investigations. Two of the 6 patients survived, 1 making a full recovery and the other with neurologic sequelae. Two patients underwent liver transplantation but died with severe neurologic sequelae despite improving liver function. The remaining 2 patients were considered too unwell to undergo liver transplantation and died in multiple organ failure. Liver histology from needle biopsy and/or native liver explants identified lesions compatible with a combination of steatosis and necrosis. Factor V and transaminase levels may allow early identification of patients in whom liver function is likely to improve spontaneously. In conclusion, the mechanisms of liver failure occurring after grand mal seizures appear multifactorial, including hypoxia, steatosis, and drug-induced components. The neurological prognosis and overall survival of these patients remains poor. F ulminant liver failure is a rare complication of status epilepticus and is associated with a high mortality. The grim prognosis in this condition appears determined by the combination of the hepatic and neurological insults, although the mechanism of the hepatic injury remains unclear. To date, there are no reports of patients offered liver transplantation for this particular cause of fulminant liver failure. We describe a series of 6 patients presenting with fulminant liver failure secondary to status epilepticus, 2 of whom survived, and report the first 2 cases of liver transplantation for this indication.The article reviews the background, medications, presentation, and clinical evolution of these patients, with a particular emphasis on hepatic and neurologic status. These data are correlated with histologic findings to bring to light possible mechanisms of the hepatic injury as well as factors that may predict its prognosis. Finally, we discuss management issues of these patients including the place of liver transplantation. Patients and MethodsPatient Recruitment. From 1994 to 2001, 251 patients with fulminant hepatitis or acute liver failure were admitted to our center. Of these, 6 patients (2 women, 4 men), mean age of 39.7 years (range, 29-58 years), were referred to our center with acute liver failure following grand mal seizures.

Modulation of pentylenetetrazole‐induced seizures and oxidative stress parameters by sodium valproate in the absence and presence of N‐acetylcysteine

“…This suggests that chemoshock also produces stress on the liver. Our results are in agreement with the reports of Baxter et al [36] and Ichai et al [37] who have reported hepatomegaly and fulminant hepatitis following seizures. Further, the addition of NAC (100 mg/kg, p.o.)…”

“…[36] and Ichai et al. [37] who have reported hepatomegaly and fulminant hepatitis following seizures. Further, the addition of NAC (100 mg/kg, p.o.)…”

Effect of pentylenetetrazol-induced epileptic seizure on the antioxidant enzyme activities, glutathione and lipid peroxidation levels in rat erythrocytes and liver tissues

“…Fulminant liver failure is a rare complication of grand mal seizures with a high mortality. The mechanisms of acute liver failure secondary to grand mal epilepsy are poorly defined and appear multifactorial, including hypoxia, steatosis and drug-induced components [9].…”

Adhesion contact dynamics of primary hepatocytes on poly(ethylene terephthalate) surface

“…Liver transplantation may be the only solution for most acute liver failure (ALF) patients but is hindered by severe shortage of organ donors [1]. A bioartificial liver assist device (BLAD) that can provide the critical hepatic functions would be extremely valuable to ALF patients [2].…”