Seizure as a Neurologic Complication After Liver Transplant

Abstract

Objectives: Seizure is a common complication after liver transplant and has been reported to occur in up to 42% of patients in different case series. Multiple factors can trigger seizures, including immunosuppressive toxicity, sepsis, metabolic imbalance, and structural brain lesions. The aim of this retrospective study was to evaluate seizure types and associated factors in adult liver transplant patients. Materials and Methods:We retrospectively evaluated the medical records of 142 adult patients who received a liver transplant between 2005 and 2013. We recorded demographic data, immunosuppressive treatment, seizure type, cause, recurrence, and treatment. Results: Of the 146 patients, 23 (15.7%) had a seizure after the liver transplant. This group included 10 females and 13 males, with ages ranging between 18 and 63 (39.9 ± 14.8 y). Generalized tonic-clonic seizures were the most common, occurring in 20 patients (87%). We observed complex partial seizure and status epilepticus in 1 and 2 patients.Immunosuppressive drug-related seizure occurred in 8 patients (34.8%) with normal drug blood levels, and all but 1 of these patients experienced seizure within the first week after transplant. Multiple factors (26.1%), metabolic imbalance (17.4%), structural lesion (13%), and sepsis (8.7%) were the other factors identified as underlying conditions. Conclusions: In conclusion, seizure occurred in a significant proportion of patients who underwent liver transplant. Immunosuppressive drugs were the most common factor associated with seizure occurrence and drug cessation prevented seizure recurrence.

Tonic-Clonic Seizure in a Liver-Transplant Recipient due to Concomitant Use of Colchicine with Cyclosporine A and Valganciclovir

“…Concordant with previous reports, tonic-clonic seizure was the commonest form of seizure in post-LT recipients [7][8][9]. About 9% to 12% of seizures in post-LT recipients were status epilepticus [7,9]. The cause of seizure could be multifactorial.…”

“…Our patient's seizure developed at ~22 weeks post-LT, which was later than the typically described period: >2/3 developed in the initial 4 weeks early post-LT or in bimodal distribution that >50% occurred in the initial week, and then 5 to 16 weeks post-LT [7][8][9]. Concordant with previous reports, tonic-clonic seizure was the commonest form of seizure in post-LT recipients [7][8][9]. About 9% to 12% of seizures in post-LT recipients were status epilepticus [7,9].…”

“…Seizure was the second most common neurologic complications post-LT [7,8], with reported incidence varied from 15% to 40% [7][8][9], and a higher incidence up to 33% in re-LT recipients [9]. Our patient's seizure developed at ~22 weeks post-LT, which was later than the typically described period: >2/3 developed in the initial 4 weeks early post-LT or in bimodal distribution that >50% occurred in the initial week, and then 5 to 16 weeks post-LT [7][8][9]. Concordant with previous reports, tonic-clonic seizure was the commonest form of seizure in post-LT recipients [7][8][9].…”

“…The cause of seizure could be multifactorial. Causes such as electrolyte and metabolic disturbances, central nervous system infection and structural abnormalities, hypoxicischaemic encephalopathy, cerebrovascular complications [7][8][9][10] had been excluded in our patient.…”

Akut symptomatische Anfälle bei internistischen Erkrankungen und Noxen

“…Doch auch bei transplantierten Patienten treten je nach Literatur ASAs bei ca. 15-30 % der Patienten auf [25,26]. In einer rezenten populationsbasierten Studie wurden Patienten mit Leberzirrhose und solche mit milder, nichtzirrhotischer Lebererkrankung verglichen.…”