Fulminant hepatitis after grand mal seizures: Mechanisms and role of liver transplantation
Corresponding Author
Philippe Ichai M.D.
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Centre Hepatobiliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier 94800, Villejuif, France. fax: (33) 1 45 59 38 57===Search for more papers by this authorEmmanuel Huguet
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorCatherine Guettier
Department of Pathology, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDaniel Azoulay
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorMaria Eugenia Gonzalez
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorBernard Fromenty
INSERM U -481, Hôpital Beaujon, Clichy, France
Search for more papers by this authorPascal Masnou
Department of Neurology, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Krêmlin-Bicêtre, Villejuif, France
Search for more papers by this authorFaouzi Saliba
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorBruno Roche
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorFahed Zeitoun
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDenis Castaing
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDidier Samuel
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorCorresponding Author
Philippe Ichai M.D.
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Centre Hepatobiliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier 94800, Villejuif, France. fax: (33) 1 45 59 38 57===Search for more papers by this authorEmmanuel Huguet
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorCatherine Guettier
Department of Pathology, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDaniel Azoulay
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorMaria Eugenia Gonzalez
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorBernard Fromenty
INSERM U -481, Hôpital Beaujon, Clichy, France
Search for more papers by this authorPascal Masnou
Department of Neurology, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Krêmlin-Bicêtre, Villejuif, France
Search for more papers by this authorFaouzi Saliba
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorBruno Roche
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorFahed Zeitoun
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDenis Castaing
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorDidier Samuel
Centre Hepatobiliaire, Assistance Publique-Hôpitaux de Paris, Universite Paris Sud, Hôpital Paul Brousse, Villejuif, France
Search for more papers by this authorAbstract
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 unwell 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.
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