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Table of Contents
Vol. 52, No. 4, 2004
Issue release date: December 2004
Section title: Original Paper
Eur Neurol 2004;52:230–236
(DOI:10.1159/000082163)

New-Onset Seizures after Liver Transplantation: Clinical Implications and Prognosis in Survivors

Choi E.J. · Kang J.K. · Lee S.A. · Kim K.H. · Lee S.G. · Andermann F.
aDepartment of Neurology, University of Korea College of Medicine, Guro Hospital, and Departments of bNeurology and cSurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; dDepartment of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Canada

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/15/2004
Accepted: 9/2/2004
Published online: 12/23/2004

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE

Abstract

Purpose: To identify the probable etiologies and characteristics of new-onset seizures after orthotopic liver transplantation (OLT) and to assess their clinical implications and prognosis. Methods: We retrospectively analyzed the clinical, electrophysiologic and laboratory data of 17 patients with new-onset seizures after OLT among 367 adult and pediatric patients who underwent OLT between 1999 and 2001. Results: A suspected etiology of seizures was identified in most patients, including 6 (35.2%) with neurotoxicity due to immunosuppressive therapy, 4 (23.5%) with cerebrovascular disease, 3 (17.6%) with severe metabolic derangement by sepsis or rejection, and 1 each (5.8%) with hyperglycemia and brain edema due to fulminant hepatic failure. Causative factors could not be identified in 2 patients (11.8%). Seizures recurred in 15 patients (88.2%), with 9 occurring on the same day as the original seizure. Attacks caused by neurotoxicity tended to have an earlier onset, within 1 week in 4 of 6 patients, than those caused by cerebrovascular disease and sepsis/rejection, but this was not statistically significant. A total of 21 EEGs were performed in 13 patients. Eleven patients had abnormal EEG findings, of whom 4 (30.7%) showed epileptiform discharges, but the outcome of patients with epileptiform activity did not differ statistically from that of patients without such discharges (p > 0.6). The incidence of poor outcome (death or persistent vegetative state) in the group with seizures was almost 10 times higher than in the group without seizures (52.9 vs. 5.7%, p < 0.001). The prognosis of patients with seizures due to cerebrovascular disease and severe metabolic derangement by sepsis/rejection was poorer than that of patients with seizures caused by the neurotoxicity of immunosuppressive drugs (p < 0.02), suggesting that the underlying cause of seizures is important in determining prognosis. Of 8 patients who survived, 1 was lost to follow-up. The long-term outcome of seizures in surviving patients was excellent, with all survivors available for follow-up being seizure-free for a mean follow-up of 42.5 months (range, 16–58 months). Conclusion: New-onset seizures after OLT may herald fatal outcome, especially in patients with cerebrovascular disease or sepsis. The prognosis of seizures in survivors is excellent, and long-term antiepileptic drugs are not required in most cases.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/15/2004
Accepted: 9/2/2004
Published online: 12/23/2004

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: http://www.karger.com/ENE


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