Seizures after orthotopic liver transplantation

Wszołek, Zbigniew K.; Steg, Robert E.

doi:10.1016/s1059-1311(97)80050-7

Cited by 36 publications

(47 citation statements)

References 22 publications

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“…[1][2][3][4] Although the seizure rate has decreased in recent studies, previous case series reported seizure prevalence rates as high as 42%. 5,6 There are various causative factors underlying seizures, including immunosuppressive drug toxicity, metabolic disturbance, infection, and structural brain lesions. 6 Generalized seizures are the most common type in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 There are various causative factors underlying seizures, including immunosuppressive drug toxicity, metabolic disturbance, infection, and structural brain lesions. 6 Generalized seizures are the most common type in this patient population. 6,7 It is difficult to establish accurate reasons for seizures in LT patients because multiple factors may influence their onset; therefore, the aim of this retrospective study was to evaluate seizure type and associated factors in adult LT patients.…”

Section: Introductionmentioning

confidence: 99%

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Seizure as a Neurologic Complication After Liver Transplant

Derle

Kibaroğlu²,

Öcal³

et al. 2015

Exp Clin Transplant

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Objectives: Seizure is a common complication after liver transplant and has been reported to occur in up to 42% of patients in different case series. Multiple factors can trigger seizures, including immunosuppressive toxicity, sepsis, metabolic imbalance, and structural brain lesions. The aim of this retrospective study was to evaluate seizure types and associated factors in adult liver transplant patients. Materials and Methods:We retrospectively evaluated the medical records of 142 adult patients who received a liver transplant between 2005 and 2013. We recorded demographic data, immunosuppressive treatment, seizure type, cause, recurrence, and treatment. Results: Of the 146 patients, 23 (15.7%) had a seizure after the liver transplant. This group included 10 females and 13 males, with ages ranging between 18 and 63 (39.9 ± 14.8 y). Generalized tonic-clonic seizures were the most common, occurring in 20 patients (87%). We observed complex partial seizure and status epilepticus in 1 and 2 patients.Immunosuppressive drug-related seizure occurred in 8 patients (34.8%) with normal drug blood levels, and all but 1 of these patients experienced seizure within the first week after transplant. Multiple factors (26.1%), metabolic imbalance (17.4%), structural lesion (13%), and sepsis (8.7%) were the other factors identified as underlying conditions. Conclusions: In conclusion, seizure occurred in a significant proportion of patients who underwent liver transplant. Immunosuppressive drugs were the most common factor associated with seizure occurrence and drug cessation prevented seizure recurrence.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Seizure as a Neurologic Complication After Liver Transplant

Derle

Kibaroğlu²,

Öcal³

et al. 2015

Exp Clin Transplant

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“…However, a substantial number of patients also have focal (20,21) or myoclonic (3,11,21) seizures, and both convulsive (3,4) and nonconvulsive (4) status epilepticus have been observed. One of the most common causes of seizures in transplant patients has been claimed to be the use of CsA (2,3,5,6).…”

Section: Discussionmentioning

confidence: 99%

“…However, 30-60% of organ-transplant recipients develop neurologic complications (2), and seizures are one of the most frequent (3,4).…”

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confidence: 99%

Cyclosporin A and Brain Excitability Studied In Vitro

1998

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Summary:Purpose: Seizures are frequently observed after organ transplantations. This has been attributed to a direct effect of cyclosporin A (CsA) on the brain, although other mechanisms may also be of importance. The aim of this study was to investigate possible acute and direct effects of CsA on neuronal excitability.Methods: Female rat hippocampal slices were perfused with CsA solutions containing 400 (n = 4), 1,000 (n = 4), 2,000 (n = 6), 8,000 (n = 8) bg/L CsA or control (n = 8) for 30 min, or penicillin, 2,000 IEfml (n = 7). Actual concentrations of CsA were measured in the perfusate drawn from the slice chamber. To study CsA accumulation in the slices, uptake of radioactive CsA was measured in 12 living and 11 dead slices.Results: Despite a significant accumulation of CsA in the living neuronal slices, no effects were observed on prevolley, field excitatory postsynaptic potential (EPSP), or population spike amplitude. Penicillin, however, led to epileptiform activity within 10 min in all cases. Concentrations of CsA in the perfusate from the slice chamber were about half the calculated levels, demonstrating that the slices had been exposed to actual CsA concentrations in the range of -200-4,000 bg/L CsA. Conclusions:Our results demonstrate a lack of acute effects of CsA on neuronal excitability within clinically relevant concentrations despite an active accumulation of the drug in the slices. Long-term effects on brain tissue, indirect metabolic effects, or synergistic effects may be responsible for the neurotoxicity of the drug. Key Words: Cyclosporin A-Seizures-Transplantation-Hippocampal slice.Cyclosporin A (CsA) is today the major immunosuppressant after all kinds of organ transplantations and is also successfully used in the treatment of various immune-mediated diseases (1). However, 30-60% of organ-transplant recipients develop neurologic complications (2), and seizures are one of the most frequent (3,4).Several studies in humans (3,5,6) and animals (7-10) suggest a seizure-inducing effect of CsA itself, even in the absence of complicating factors like metabolic disturbances and concomitant treatment. The possibility of an acute effect of the drug on brain excitability is supported by the observation that seizures occur more frequently after intravenous administration of CsA (3,ll). Seizures also have been observed even during the intravenous infusion (3,12) in patients who had not previously had seizures.The human data could thus indicate an acute and direct epileptogenic effect on neuronal excitability, whereas studies in intact animals (7-10) and cell cultures (13) suggest an effect evolving with time over days or weeks.The aim of this study was therefore to investigate whether CsA exerts direct effects on neuronal excitabilAccepted January 16, 1998. Address correspondence and reprint requests to Dr. E. Tauboll at Department of Neurology, Rikshospitalet, 0027 Oslo, Norway. ity, by using a hippocampal slice technique devoid of blood-brain barrier. METHODSFemale Sprague-Dawley rats (150-250 g; M...

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“…Diminuição do nível de consciência é uma das alterações mais precoces e pode ser consequência de fatores tão variados quanto a hipoglicemia e doença cerebrovascular (DCV) 2,3,6,7,[9][10][11]15,17 . Convulsões afetam de 6 a 36 % dos pacientes e costumam ser únicas e tônico-clônicas generalizadas 2,3,6,[7][8][9][10][11][13][14][15][16][17] . As infecções ocorrem em 5 a 10 % dos pacientes e podem ser convencionais, no período mais precoce do transplante, ou oportunistas, e são de alta mortalidade [1][2][3]6,[9][10][11]15,17 .…”

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Alterações neurológicas em pacientes submetidos a transplante hepático: análise de 30 casos consecutivos

Vecino

Cantisani

Zanotelli

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -As complicações neurológicas em transplante hepático (TxH) são importante causa de morbimortalidade, pois as intercorrências podem resultar de fatores prévios ao TxH, de alterações trans-operatórias, de dificuldades com os imunossupressores, coagulopatias e infecções do período pós-operatório. Nós analisamos , retrospectivamente, a cronologia, as causas e as frequências das alterações neurológicas de 30 pacientes adultos submetidos a TxH e constatamos que nossos resultados diferem ligeiramente dos apresentados em outras séries. PALAVRAS-CHAVE: alterações neurológicas, transplante hepático. Neurologic alterations in patients submitted to liver transplantation: analysis of 30 consecutive casesABSTRACT -Neurologic complications are important source of morbi-mortality, in liver transplantation. They result from previous factors, alterations during the surgical procedure, effects from immunosuppresor drugs, coagulopathy and infections. We analyzed, retrospectively, the chronology, causes, and frequencies of neurologic alterations in thirty adult patients submitted to liver transplantation, and our results differ slighty from those registered in other series. KEY-WORDS: neurologic alterations, liver transplantation.Alterações neurológicas em transplante hepático (TxH) são importante causa de morbimortalidade, podendo afetar de 13,2 a 90% dos pacientes, conforme as diferentes séries 1,-3, 6-7, 9-11,14,18 , e ter origem central ou periférica. As intercorrências podem resultar de fatores prévios ao transplante como os relacionados ao alcoolismo, a infecção pelo vírus da hepatite C e a desnutrição, ou de alterações trans-operatórias e de dificuldades com imunossupressores, que vão desde efeitos colaterais extra-piramidais até as infecções, coagulopatias e infecções do período pós-operatório 2,3,6,[8][9][10][11][12]15,17,18 . Diminuição do nível de consciência é uma das alterações mais precoces e pode ser consequência de fatores tão variados quanto a hipoglicemia e doença cerebrovascular (DCV) 2,3,6,7,[9][10][11]15,17 . Convulsões afetam de 6 a 36 % dos pacientes e costumam ser únicas e tônico-clônicas generalizadas 2,3,6,[7][8][9][10][11][13][14][15][16][17] . As infecções ocorrem em 5 a 10 % dos pacientes e podem ser convencionais, no período mais precoce do transplante, ou oportunistas, e são de alta mortalidade [1][2][3]6,[9][10][11]15,17 . A cefaléia é uma queixa

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Seizures after orthotopic liver transplantation

Cited by 36 publications

References 22 publications

Seizure as a Neurologic Complication After Liver Transplant

Seizure as a Neurologic Complication After Liver Transplant

Cyclosporin A and Brain Excitability Studied In Vitro

Alterações neurológicas em pacientes submetidos a transplante hepático: análise de 30 casos consecutivos

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