Chronic liver disease and hepatic encephalopathy patients with new-onset focal motor status epilepticus: Indicates herpetic encephalitis

Seizures are not common in cases with chronic liver disease. Overall seizures have been reported in 20–30% of cases in chronic liver disease associated with hepatic encephalopathy. We report two cases of chronic liver disease patients who presented with new-onset refractory focal status epilepticus (SE). Both patients had encephalitis and seizures which responded only when acyclovir was added to the treatment with antiepileptic medication. Herpes encephalitis should be considered as a possible diagnosis in new-onset focal seizures or focal SE in patients with chronic liver disease with or without hepatic encephalopathy, pending further investigations.