Generalized Periodic Epileptiform Discharges in Patients with Severe Hepatic Encephalopathy: What Do They Mean?

Introduction: Electroencephalography (EEG) in a setting of specialized hospital taking care of liver and biliary diseases, has the primary role of confirming a diagnosis of metabolic encephalopathy, especially early, and ruling out nonconvulsive status epilepticus as the cause of poor consciousness level. Generalized periodic epileptiform discharges (GPEDs) are a frequent finding in these patients and their significance is not clear. Our objective was to determine the profile of EEGs of subjects with severe hepatic encephalopathy, to note the frequency of GPEDs among them, and find any relationship with patients’ clinical features and outcome. Methods: Consecutive EEGs done for patients admitted in the liver intensive care unit in the last 6 months, with the diagnosis of hepatic encephalopathy grade 3 and above were reviewed. All the available clinical information was extracted, tabulated, and analyzed. Results: A total of 262 patients were admitted between November 1, 2025 and April 30, 2026 with the diagnosis of hepatic encephalopathy grade 3 and above; 419 EEGs were performed on these patients. There were 23 patients and 54 EEGs with GPEDs and out of them, 3 recovered and 15 expired. The GPEDs improved with a loading dose of antiseizure medication (ASM) in 5 and with management of encephalopathy in 9. Conclusion: GPEDs are found in less than 10% of patients with hepatic encephalopathy. In some, it may represent seizure activity, and loading dose of ASM may improve the sensorium in these severely ill patients. Few options of ASMs are available to these patients, due to their metabolic derangement. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India