Fulminant liver failure is a rare complication of grand mal seizures. It has high mortality.
Mechanisms of acute liver failure following grand mal epilepsy, and the place of liver transplantation, are unclear.
In this study, researchers from France evaluated 6 patients with acute liver failure following grand mal seizures.
All patients had a history of chronic primary or post-traumatic epilepsy.
The investigators collected data on patients' background, presentation, and management. They also performed blood, radiologic, and histologic investigations.
|Liver histology showed lesions compatible with a combination of steatosis and necrosis.|
Overall, 2 of the 6 patients survived. Of these, 1 made a full recovery, while the other had neurologic sequelae.
A further 2 patients underwent liver transplantation, however, they died with severe neurologic sequelae despite improving liver function.
The remaining 2 patients were too unwell to undergo liver transplantation and died.
The research team found that liver histology showed lesions compatible with a combination of steatosis and necrosis.
They also found that factor V and transaminase levels may allow early identification of patients in whom liver function is likely to improve spontaneously.
Dr Philippe Ichai's team concluded, "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".