Encephalopathy medical therapy

Encephalopathy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Treatment is symptomatic and varies, according to the type and severity of the encephalopathy. Anticonvulsants may be prescribed to reduce or halt any seizures. Changes to diet and nutritional supplements may help some patients. In severe cases, dialysis or organ replacement surgery may be needed.

Medical therapy

• General management of patients is important. Stabilizing the patient and treating the specific cause is the basis of management.
• Airway , breathing and circulation are to be maintained well as the patient may deteriorate any time owing to brain dysfunction.
• All drugs which have potential of effecting brain function have to be discontinued.
• Haloperidol has to be given to prevent seizures as a prophylactic. But it has to be avoided in cases of alcohol withdrawal.
• In cases of alcoholic encephalopathy, thiamine should be administered as soon as possible.

Hepatic encephalopathy

Patients with hepatic encephalopathy are treated taking into account three things.

• General condition
  • Care of airways as they may go into respiratory distress any moment.
  • Prophylactic intubation
  • Treating the precipitants

• Increased clearance of ammonia
  • Use of L-ornithine L-aspartate (LOLA) which uses ammonia in the body to form glutamine from glutamate
  • L-carnitine improves the blood ammonia levels
  • Sodium benzoate interacts with glycine in the body and leads to excretion of ammonia
  • Sodium phenylacetate also results in excretion of ammonia from the body
  • Zinc deficiency causes decreased functioning of urea cycle enzymes. With administration of zinc levels of ammonia decrease.

• Decreased production of ammonia
  • Lactulose administration leads to inhibition of intestinal bacteria which produce ammonia
  • Neomycin is used to decrease the colonic bacterial load and decrease the ammonia levels
  • Rifaximin is a non absorbable antibiotic which destroys colonic bacteria

Hypoxic encephalopathy

• Commonly seen in neonates as perinatal asphyxia
• Proper ventilation has to be maintained
• Maintenance of perfusion
• Prevention of seizures
• Hypothermia can be useful as it decreases brain's metabolic need.

Hypertensive encephalopathy

• Aim is to reduce the diastolic blood pressure to a range of 100-105 in 2- 6 hrs.
• Massive reduction of blood pressure is also not advisable as it may cause ischemic attacks.
• Initially infusions are used to control blood pressure and then switched to oral therapy
• Infusion drugs used are niardipine, nitroprusside and labetolol
• Oral drugs used are nifedipine, captopril