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Epilepsy in Renal, Hepatic, and Other Conditions 

Epilepsy in Renal, Hepatic, and Other Conditions
Epilepsy in Renal, Hepatic, and Other Conditions

Aidan Neligan

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date: 19 May 2022

Aetiology is an important determinant of prognosis in epilepsy yet is largely ignored in the ILAE classifications of seizures and epileptic syndromes. This is of particular relevance when discussing seizures occurring in the context of systemic diseases and where they should fit in such a classification. Seizures in systemic diseases are not an inconsiderable problem, especially in the critically ill. The currently used terms, acute and remote symptomatic seizures (as differentiated by the temporal relationship to the provoking factor), are confusing and probably too simplistic as most seizures occurring in systematic disease are likely to be multi-factorial even if one cause predominates. In a recently proposed aetiological classification of epilepsy, epilepsy is divided into four broad categories: idiopathic, symptomatic, provoked or cryptogenic epilepsy. The term provoked seizures seems more appropriate for seizures in the context of systematic disease which may occur as a direct consequence of the underlying condition, its predisposing factors, its treatment or a combination of all three. Estimating the true frequency of seizures in people with primarily non-neurological conditions is difficult as this has rarely been subject to systematic examination. Nevertheless it does seem that seizures are one of the more common neurological manifestations of systemic disease. In a prospective study of all admissions to a medical ITU over a two-year period, 1850 people were identified, of whom 92 were admitted with a primary neurological condition. Of the remaining 1758 people, 217 (12.3%) developed neurological complications of which 61 (28%) were seizures. Seizures arising as a consequence of systemic disease can be convulsive or non-convulsive, focal or generalized (either primary or secondary generalized) and particularly status epilepticus (convulsive and non-convulsive), the majority of which occurs in people with no prior history of epilepsy. A high index of suspicion for the possibility of subtle convulsive or non-convulsive status epilepticus (NCSE) as well as the possibility of non-epileptic seizures needs to be maintained in the critical care setting. In this chapter, we will primarily deal with what are termed situation-related seizures and as such the seizures can be explained by the provoking circumstances. We shall not deal further with epileptic syndromes in which systemic disease features prominently such as the progressive myoclonus epilepsy action myoclonus-renal syndrome (AMRF) or genetic or metabolic conditions such as Glucose transporter type 1 (GLUT-1) deficiency syndrome in which seizures frequently occur.

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