Newey CR, et al. – An analysis was performed to highlight the observed electro–radiological changes in patients with grade III/IV hepatic encephalopathy (HE) found to have seizures and/or status epilepticus on continuous electroencephalography (CEEG) and the correlated neuroimaging. In the setting of HE, seizures or status epilepticus were without clinical findings and could go unrecognized without CEEG. For unrecognized seizure or status epilepticus, the finding of cortical hyperintensity on magnetic resonance imaging (MRI) necessitated further evaluation.

• The authors conducted a retrospective review of patients with West Haven grade III/IV HE and seizures/status epilepticus on CEEG.

• The authors included 11 patients.
• The most common cause of HE was alcohol (54.5%).
• In this study, all patients were either stuporous/comatose.
• Diffuse slowing (100%) was the most common CEEG pattern followed by generalized periodic discharges (GPDs; 36.4%) and lateralized periodic discharges (LPDs, 36.4%).
• They observed the subtype of GPDs with triphasic morphology only in 27.3%.
• All seizures and/or status epilepticus were without clinical signs.
• In 6 patients, MRI was available.
• They observed cortical hyperintensities on diffusion weighted imaging sequence in all 6 patients.
• 1 patient had CEEG seizure concomitantly with the MRI.
• Prior to discharge, 7 patients died.