Unusual Facial Movements (Ictal Blinking, Oculogyric Crises, and Jaw Seizure) in Severe Liver Disease: A Case Series

Abstract

BackgroundSeizures are reported in about one third of patients with severe liver disease in association with acute or chronic liver failure. Majority of the seizures are of focal type. Occasionally generalized tonic clonic seizures are seen when there is ethanol withdrawal. Not much is known about Ictal blinking (IB) in severe liver disease. IB is rare form of seizures and was reported in severe liver disease recently from this institute. Oculogyric crisis (OGC) is rarely reported in relation to the severe liver disease. OGC was also noted first time in our Intensive Care Unit.MethodsAt the institute of liver and biliary sciences (ILBS) data on patients with IB and OGC was analyzed from October 2018 to January 2023 (52 months). All the patients had video electroencephalograph (video-EEG) recording after proper permission/consent. The patients were followed up later for the course of the illness.Results16 (12M: 4F) patients were seen. Majority 12 (75 %) were IB and 3 OGC.EEG was abnormal in nine (75.0%) of IB patients. Brain imaging had nonspecific findings. Outcome was based on the severity and recovery of the underlying liver disease.ConclusionsUnusual facial movements in form of IB and OGC are reported, which are most of the time missed. This report highlights the importance of recognition of these events and proper in time management to improve the outcome.