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Atlas of Neurology—A Case-based Approach
by Satish V Khadilkar, Kalyan B BhattacharyyaThe common causes of metabolic encephalopathies include hepatic failure (where sometimes myoclonus may be negative due to loss of muscle tone, often known as asterixis), renal failure, hyponatremia, glycaemic changes, hyperthyroidism, metabolic acidosis or alkalosis, Hashimoto encephalopathy, and anoxic damage to the brain (Lance Adams syndrome). Usually, it is cortical in nature where the EEG precedes and EMG correlate by at least 30 msec and giant N20 potential in somatosensory evoked potential study is sometimes observed. The EEG shows slowing of the background activity, sometimes with triphasic waves. They respond to correction of hyponatremia, valproate, clonazepam, piracetam, and levetiracetam therapy.
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