Reviewer ’s report  
 
Title: Epilepsy as a risk factor for hepatic encephalopathy in patient s with cirrhosis: a cohort 
study  
 
Version: 0 Date: 01 Feb 2016  
 
Reviewer: Ben Woolbright  
 
Reviewer's report:  
 
The following is a review of "Epilepsy as a risk factor for hepatic encephalopathy in patients 
with cirrhosis: a cohort study" by Jepsen and colleauges, an established group. This study is a 
follow -up from a previous larger report from the authors. The aut hors should be commended on 
their acquisition of a large patient database that allows for the detection of potential risks in rare 
co-morbidities such as entailed in the manuscript. I agree with the authors that despite the small 
sample size of the epileps y populations, it is unlikely that larger cohorts will be acquired without 
significant effort, and thus this study has some value. The data are very well discussed with a 
particularly effective discussion of the potential weaknesses in the data set.  
 
 
 
1) Given the overabundance of patients in the no epilepsy group, why include the Hep B 
alone patients and the NASH/cryptogenic patients as there was not even a single 
patient in this group in the epilepsy group. Wouldn't it make more sense to just 
exclude these groups and do a direct comparison between groups where epilepsy is 
present?  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, conside ring the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  
If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wis h to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Epilepsy as a risk factor for hepatic encephalopathy in patient s with cirrhosis: a cohort 
study  
 
Version: 0 Date: 01 Feb 2016  
 
Reviewer: Ben Woolbright  
 
Reviewer's report:  
 
The following is a review of "Epilepsy as a risk factor for hepatic encephalopathy in patients 
with cirrhosis: a cohort study" by Jepsen and colleauges, an established group. This study is a 
follow -up from a previous larger report from the authors. The aut hors should be commended on 
their acquisition of a large patient database that allows for the detection of potential risks in rare 
co-morbidities such as entailed in the manuscript. I agree with the authors that despite the small 
sample size of the epileps y populations, it is unlikely that larger cohorts will be acquired without 
significant effort, and thus this study has some value. The data are very well discussed with a 
particularly effective discussion of the potential weaknesses in the data set.  
 
 
 
1) Given the overabundance of patients in the no epilepsy group, why include the Hep B 
alone patients and the NASH/cryptogenic patients as there was not even a single 
patient in this group in the epilepsy group. Wouldn't it make more sense to just 
exclude these groups and do a direct comparison between groups where epilepsy is 
present?  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, conside ring the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  
If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wis h to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Epilepsy as a risk factor for hepatic encephalopathy in patient s with cirrhosis: a cohort 
study  
 
Version: 0 Date: 01 Feb 2016  
 
Reviewer: Ben Woolbright  
 
Reviewer's report:  
 
The following is a review of "Epilepsy as a risk factor for hepatic encephalopathy in patients 
with cirrhosis: a cohort study" by Jepsen and colleauges, an established group. This study is a 
follow -up from a previous larger report from the authors. The aut hors should be commended on 
their acquisition of a large patient database that allows for the detection of potential risks in rare 
co-morbidities such as entailed in the manuscript. I agree with the authors that despite the small 
sample size of the epileps y populations, it is unlikely that larger cohorts will be acquired without 
significant effort, and thus this study has some value. The data are very well discussed with a 
particularly effective discussion of the potential weaknesses in the data set.  
 
 
 
1) Given the overabundance of patients in the no epilepsy group, why include the Hep B 
alone patients and the NASH/cryptogenic patients as there was not even a single 
patient in this group in the epilepsy group. Wouldn't it make more sense to just 
exclude these groups and do a direct comparison between groups where epilepsy is 
present?  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, conside ring the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  
If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wis h to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant