Cirrhosis tied to heightened risk of status epilepticus
Cirrhosis is linked to status epilepticus, although there appears to be no overall association between liver disease and seizures, according to a large cohort study.
Researchers reviewed the medical data of 10,393 Medicare beneficiaries with cirrhosis and 19,557 with mild, noncirrhotic liver disease to evaluate the risks of seizure (primary outcome) and status epilepticus (secondary outcome). Survival statistics and Cox proportional hazards models were used in the analyses.
Patients with vs without liver disease were older and had more seizure risk factors. During a follow-up of 4.6 years, 49,843 (2.8 percent) individuals were diagnosed with seizures and 25 (0.001 percent) were found to have status epilepticus.
Cirrhosis was associated with status epilepticus (hazard ratio [HR], 1.9; 95 percent CI, 1.3–2.8) but not with seizures (HR, 1.1; 1.0–1.3). Furthermore, mild liver disease did not exert any influence on the risk of seizures (HR, 0.8; 0.6–0.9) or status epilepticus (HR, 1.1; 0.7‐1.5).
The findings indicate that although metabolic derangements often cause seizures, and although liver disease is frequently implicated in metabolic derangements and neurological deficits such as encephalopathy, there is generally no independent association between liver disease and seizures, as researchers pointed out.
Meanwhile, the relationship between cirrhosis and status epilepticus could represent a true link, indicating that cirrhosis can increase the risk of seizures that are prolonged and severe, researchers continued. It is also possible that the association may be due to detection bias from more frequent hospitalizations in patients with cirrhosis, or a chance finding given the generally negative association between cirrhosis and seizures, as well as the very small number of patients with status epilepticus.
More studies are therefore needed to further investigate the association between cirrhosis and status epilepticus before any definitive inferences can be made, they said.