Epileptiform abnormalities in hepatic encephalopathy

Epileptiform abnormalities are uncommon in patients with hepatic encephalopathy. A review of EEGs in patients with hepatic encephalopathy over a 10-year period identified 18 (15%) with epileptiform abnormalities. Thirteen patients had interictal discharges consisting of focal spike and sharp wave discharges, bilateral independent discharges, and generalized spike and wave discharges. A total of 10 patients had electrographic seizure discharges, focal in 6 and generalized in 5 (some patients had more than one abnormality). Twelve patients had clinical seizures, partial in four and generalized in eight. Neuroimaging failed to provide an etiology for the generation of epileptiform discharges in most patients, including those with focal abnormalities. Most patients 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.