Fulminant hepatic failure associated with status epilepticus in children: three cases and a review of potential mechanisms

Intensive Care Med. 1994 May;20(5):375-8. doi: 10.1007/BF01720913.


Fulminant hepatic failure is a rare complication of status epilepticus. Although many of the anticonvulsants used to treat the seizures are known to have hepatotoxic properties, the exact mechanism leading to massive destruction of the liver following a prolonged seizure remains unclear. Three children are presented who developed fulminant hepatic failure following status epilepticus and subsequently died of multiple organ failure. The literature is reviewed with particular attention to the possible interaction between the anticonvulsants and the metabolic consequences of status epilepticus. We postulate that it is a combination of hypoxia and ischemia that occurs during a prolonged seizure with altered metabolism of free radicals secondary to the anticonvulsant drugs which leads to widespread hepatocyte membrane damage.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anticonvulsants / adverse effects
  • Brain / pathology
  • Child
  • Fatal Outcome
  • Free Radicals / metabolism
  • Hepatic Encephalopathy / drug therapy
  • Hepatic Encephalopathy / etiology*
  • Hepatic Encephalopathy / metabolism
  • Hepatic Encephalopathy / pathology
  • Humans
  • Liver / drug effects
  • Liver / metabolism
  • Liver / pathology
  • Male
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / pathology
  • Necrosis
  • Status Epilepticus / complications*
  • Status Epilepticus / drug therapy
  • Status Epilepticus / metabolism
  • Status Epilepticus / pathology


  • Anticonvulsants
  • Free Radicals