Cui Bin, Wei Lin, Sun Li-Ying, Qu Wei, Zeng Zhi-Gui, Liu Ying, Zhu Zhi-Jun
Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
World J Clin Cases. 2020 Dec 26;8(24):6480-6486. doi: 10.12998/wjcc.v8.i24.6480.
Status epilepticus in patients with hepatic encephalopathy (HE) is a rare but serious condition that is refractory to antiepileptic drugs, and current treatment plans are vague. Diagnosis may be difficult without a clear history of cirrhosis. Liver transplantation (LT) is effective to alleviate symptoms, however, there are few reports about LT in the treatment of status epilepticus with HE. To our knowledge, this is the first report of status epilepticus present as initial manifestation of HE.
A 59-year-old woman with a 20-year history of heavy drinking was hospitalized for generalized tonic-clonic seizures. She reported no history of episodes of HE, stroke, spontaneous bacterial peritonitis, ascites or gastrointestinal bleeding. Neurological examination revealed a comatose patient, without papilledema. Laboratory examination suggested liver cirrhosis. Plasma ammonia levels upon admission were five times normal. Brain computed tomography (CT) was normal, while abdominal CT and ultrasound revealed mild ascites, liver cirrhosis and splenomegaly. Electroencephalography (EEG)showed diffuse slow waves rhythm, consistent with HE, and sharp waves during ictal EEG corresponding to clinical semiology of focal tonic seizures. The symptoms were reversed by continuous antiepileptic treatment and lactulose. She was given oral levetiracetam, and focal aware seizures occasionally affected her 10 mo after LT.
Status epilepticus could be an initial manifestation of HE. Antiepileptic drugs combined with lactulose are essential for treatment of status epilepticus with HE, and LT is effective to prevent the relapse.
肝性脑病（HE）患者的癫痫持续状态是一种罕见但严重的疾病，对抗癫痫药物难治，目前的治疗方案尚不明确。如果没有明确的肝硬化病史，诊断可能会很困难。肝移植（LT）对缓解症状有效，然而，关于LT治疗HE伴癫痫持续状态的报道很少。据我们所知，这是首例以癫痫持续状态为HE初始表现的报道。
一名有20年酗酒史的59岁女性因全身强直阵挛发作入院。她报告无HE发作、中风、自发性细菌性腹膜炎、腹水或胃肠道出血病史。神经系统检查发现患者昏迷，无视乳头水肿。实验室检查提示肝硬化。入院时血浆氨水平是正常水平的5倍。脑部计算机断层扫描（CT）正常，而腹部CT和超声显示轻度腹水、肝硬化和脾肿大。脑电图（EEG）显示弥漫性慢波节律，与HE一致，发作期EEG出现尖波，与局灶性强直发作的临床症状相符。持续抗癫痫治疗和乳果糖使症状得到缓解。她接受了口服左乙拉西坦治疗，肝移植后10个月偶尔仍有局灶性清醒发作。
癫痫持续状态可能是HE的初始表现。抗癫痫药物联合乳果糖对治疗HE伴癫痫持续状态至关重要，肝移植对预防复发有效。
