In patients with a known diagnosis of cirrhosis, hepatic exacerbations may increase the risk for hospitalization for epilepsy and status epilepticus up to 6 months following the exacerbating event, according to study results published in Epilepsia.
While chronic liver disease is associated with various neurological complications, including seizures, the impact of exacerbations of cirrhotic liver disease on patients with epilepsy is unknown. The goal of this epidemiological study was to explore the association between an acute hepatic exacerbation and risk for epilepsy or status epilepticus admissions over time.
Using the New York State Inpatient Database from 2005 to 2013, the researchers identified 61,874 index admissions for epilepsy and 11,818 index admissions for status epilepticus. Hepatic exacerbation included admission with a diagnosis of cirrhosis with at least one of the following: esophageal varices, ascites, peritonitis, hepatorenal syndrome, or hepatic encephalopathy.
The researchers performed a case-crossover analysis for each index event in separate models and examined exposures in discrete intervals of time leading to the outcomes.
Case-crossover analyses found a significant association between hepatic exacerbation and subsequent admission for epilepsy in all time windows, except for the 14-day period, as the association became significant in the 30-day window (odds ratio [OR] 2.072, 95% CI 1.095-3.92, P =.0252), and peaked in the 150-day window prior to index epilepsy admission (OR 2.742, 95% CI, 1.817-4.137, P <.0001).
This effect was even higher for status epilepticus, with a 3- to 5-fold increased likelihood of admission with status epilepticus between 14 and 180 days. The association between hepatic exacerbation and subsequent admission for status epilepticus peaked at the 90-day window prior to index admission (OR 4.615, 95% CI, 2.534-8.406, P <.0001).
The researchers acknowledged several study limitations, including the retrospective design, focus on inpatient cases and missing data on the treatments and interventions.
“Our study supports the hypothesis that hepatic exacerbations may function as a trigger for future hospital admissions for epilepsy and status epilepticus across a variety of different timeframes up to 6 months following the hepatic exacerbation,” concluded the researchers.
Gursky JM, Rossi KC, Jetté N, Dhamoon MS. Exacerbation of hepatic cirrhosis may trigger admission for epilepsy and status epilepticus [published online ahead of print, 2020 Jan 24]. Epilepsia. doi:10.1111/epi.16437