[Electroencephalographic study of the effect of a benzodiazepine antagonist in hepatic encephalopathy].
Observing animal models of fulminant hepatic failure lead to the hypothesis of a GABAergic origin of the comatose state in hepatic encephalopathy (HE). The hypothesis of hyperstimulation of gamma-aminobutyric acid-benzodiazepine (GABA-BZ) receptors in HE has been tested with a BZ antagonist (flumazenil, Anexate) on 7 patients suffering from severe HE. The standard EEG has been recorded 30 min before and after slow IV perfusion of 1 mg flumazenil. Although we did not observe a complete EEG normalization, a significant improvement of EEG was observed after only a few minutes in 6 out of the 7 cases studied. Modification of the reactivity parallels clinical improvement of encephalopathy. These effects persist mostly 4 h after perfusion. The results are consistent with the hypothesis of hyperstimulation of GABA-BZ receptors in HE. The positive effect of flumazenil on vigilance level should encourage its use in chronic hepatic encephalopathy.
Pidoux
B
B
Service d'explorations fonctionnelles neurologiques, Hôpital de la Salpêtrière, Paris, France.
Zylberberg
P
P
Valla
D
D
Opolon
P
P
D000328:Adult; D000368:Aged; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D005442:Flumazenil / Q000494:pharmacology / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011963:Receptors, GABA-A / Q000187:drug effects*
D011963:Receptors, GABA-A; D005442:Flumazenil
Etude électro-encéphalographique de l'effet d'un antagoniste des benzodiazépines dans l'encephalopathie hépatique.