Can repeated episodes of OHE in my mom cause brain damage?

Question

Hello doctor,

My mother is 54 years old and has hepatitis B–related cirrhosis. She recently experienced an episode of overt hepatic encephalopathy (OHE), with sleep reversal and confusion. Although she improved after hospital treatment, she still seems slow to respond. Is this residual encephalopathy or a normal part of recovery?

She is currently taking Duphalac syrup, but she complains of severe gas and abdominal cramps. Are there alternative dosing strategies or options to reduce these side effects?

Also, can repeated episodes of OHE cause permanent brain damage over time? We are concerned because she was previously fully independent but now requires supervision.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you so much for sharing your concern with me.

Your mother’s symptoms are consistent with recovery from hepatic encephalopathy, a complication of liver cirrhosis related to hepatitis B. After treatment, it is common for patients to remain slightly slow in thinking or responses for some time. This does not necessarily mean the treatment failed; the brain may take days to weeks to fully recover after an episode.

Currently, she is using Lactulose (Duphalac) as the primary drug for the reduction of ammonia. It is recommended that she should have two to three soft bowel movements daily. Intolerance to gas, bloating, and cramps is expected due to the fermentation of lactulose by intestinal bacteria. This condition can be overcome through dose fractionation, dose adjustment, and ingestion of lactulose at mealtime. Should intolerance continue, then a drug called rifaximin will be added since it reduces ammonia-producing bacteria allowing for reduced doses of lactulose.

With respect to complications and adverse effects of long-term therapy, it is possible for the patient to develop permanent cognitive dysfunction after multiple episodes of hepatic encephalopathy if not properly controlled. But for most patients, they regain their function after prevention of triggers and proper use of drugs.

It is important to watch for early warning signs such as sleep reversal, confusion, personality changes, or hand tremor, and seek medical advice promptly.

With proper treatment, medication adherence, and regular monitoring by their liver specialists, many patients can reduce recurrence and maintain independence for a long time.

I hope this explanation helps, and if you have any further questions, please feel free to ask at any time.

Thank you.