Benzodiazepine antagonist in the treatment of human hepatic encephalopathy

Advances in Experimental Medicine and Biology
P Ferenci, G Grimm

Abstract

Recently it was suggested that hepatic encephalopathy (HE) is mediated by an increased GABA-ergic tone. The logical consequence of such a hypothesis is the use of antagonists of the GABA -benzodiazepine receptor for treatment of HE. The experience with these drugs in human HE is limited. In order to get an estimate of the efficacy of this type of drug in humans 20 consecutive episodes of HE in 17 patients with acute or chronic liver failure were treated with flumazenil. All patients entered into the study were encephalopathic for up to 120 hours and failed to respond to conventional therapy. After an observation period of 8 hours, 15 mg of flumazenil were infused intravenously over 3 hours. Before and after treatment patients were examined neurologically and the Glasgow coma scale was calculated. In addition, somatosensory evoked potentials were recorded. In 5 out of 11 episodes in 10 patients with fulminant hepatic failure and in 7 out of 9 episodes in 7 patients with cirrhosis an unequivocal amelioration of HE was observed. The response to treatment occurred very rapidly. After stopping treatment in 8 out of these 12 episodes HE worsened again after 2 to 4 hours. The favourable clinical response was also documented by improve...Continue Reading

Citations

Apr 21, 2005·Journal of Neurosurgical Anesthesiology·Masayuki YanoTatsuru Arai
Sep 1, 2005·The American Journal of Gastroenterology·Mark T Keegan, David J Plevak
Nov 27, 2010·Emergency Medicine Clinics of North America·Adhi N Sharma, Robert J Hoffman

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