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

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.