title: 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 ill 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.
authors.affiliation: Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France. philippe.ichai@pbr.ap-hop-paris.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huguet
authors.forename: Catherine
authors.initials: C
authors.lastname: Guettier
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Gonzalez
authors.forename: Bernard
authors.initials: B
authors.lastname: Fromenty
authors.forename: Pascal
authors.initials: P
authors.lastname: Masnou
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Fahed
authors.initials: F
authors.lastname: Zeitoun
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications; D004830:Epilepsy, Tonic-Clonic / Q000150:complications* / Q000401:mortality; D005234:Fatty Liver / Q000150:complications; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome