Non-Convulsive Status Epilepticus in Hepatic Encephalopathy: A Case Series and Review of the Literature

Abstract

Hepatic encephalopathy is a common complication in chronic liver disease and cirrhosis. Here we describe two patients with hepatic encephalopathy who did not respond to standard empiric treatment and were found to have non-convulsive status epilepticus. Both patients improved with antiepileptic therapy. Non-convulsive status epilepticus should be considered in the differential diagnosis of patients with suspected hepatic encephalopathy who do not respond to empiric treatment. LEARNING POINTS • Non-convulsive status epilepticus (NCSE) is a rare complication of hepatic encephalopathy (HE). • Clinical evaluation should be used to rule out different causes of altered mental status in patients with chronic liver disease. • Consider EEG to diagnose NCSE in patients with suspected HE not responding to empiric treatment.