title: Status epilepticus in patients with cirrhosis: How to avoid misdiagnosis in patients with hepatic encephalopathy.
abstract: OBJECTIVE
  Status epilepticus (SE) in patients with cirrhosis is a rare but serious situation. Diagnosis may be difficult in emergency presentation, especially when patients present with hepatic encephalopathy (HE). Misdiagnosis must be avoided since some anti-epileptic drugs aggravate HE. In this retrospective study, we therefore assessed the frequency of SE in patients with cirrhosis, evaluated the accuracy of diagnosis and determined rates of mortality.
  
  
  METHODS
  We reviewed data from all patients hospitalized from 2005 to 2013 in the Hepatology ICU for complications of cirrhosis with an initial diagnosis of SE. We attempted to reach a consensus decision on a possible diagnosis of SE in reviews of EEG traces and medical records by an expert electrophysiologist, a hepatologist and a neurologist.
  
  
  RESULTS
  An initial diagnosis of SE was made for 20 patients with cirrhosis. Critical review suggested that 15 of these patients were correctly diagnosed with true SE. However, initial diagnoses may have been mistaken for at least 3 patients, who presented clinical and electrical signs of HE without evidence for SE. Overall, we estimated a prevalence of 0.7% for SE in patients with cirrhosis (15 of 2010 patients admitted to our ICU) in our series. In-hospital mortality was of 73%. In the 12 months after the SE episode, mortality was 87%.
  
  
  CONCLUSIONS
  As SE may be misdiagnosed in patients with cirrhosis, a joint review of the patients by neurologists and hepatologists could reduce errors in diagnosis.
authors.affiliation: Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Unité de Soins Intensifs d'Hépatologie, Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: marika_rudler@yahoo.fr.
authors.forename: Marika
authors.initials: M
authors.lastname: Rudler
authors.affiliation: Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Unité de Réanimation Neurologique, Fédération de Neurologie 1, Pôle des maladies du système nerveux, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Marois
authors.affiliation: Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Unité de Réanimation Neurologique, Fédération de Neurologie 1, Pôle des maladies du système nerveux, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut de Neurosciences Translationnelles de Paris, Institut-Hospitalo-Universitaire-A-Institut du Cerveau et de la Moelle (IHU-A-ICM), Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Weiss
authors.affiliation: Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France; Unité de Soins Intensifs d'Hépatologie, Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.affiliation: Institut de Neurosciences Translationnelles de Paris, Institut-Hospitalo-Universitaire-A-Institut du Cerveau et de la Moelle (IHU-A-ICM), Paris, France; Sorbonne University, UPMC Univ. Paris 06, F-75005, Paris, France; AP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Department of Clinical Neurophysiology, Institut du Cerveau et de la Moelle (ICM, INSERM UMRS1127, CNRS UMR7225, UPMC) F-75013, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Navarro
mesh_terms: D000368:Aged; D003951:Diagnostic Errors; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis*; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D015995:Prevalence; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000150:complications*; D016896:Treatment Outcome
keywords: Cirrhosis; Hepatic encephalopathy; Status epilepticus