Benefits of Early Treatment for Patients with Hepatic Myelopathy Secondary to TIPS: A Retrospective Study in Northern China

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for reducing portal pressure. Hepatic myelopathy (HM), a rare complication of chronic liver diseases, remains obscure in terms of treatment and prognosis. We aimed to determine an optimal treat strategy for patients with HM after TIPS. Twenty-nine patients who developed HM after TIPS were stratified by time-lapse from onset to treatment: group A (n = 16), <6 months; group B (n = 13), ≥6 months. Therapeutic measures included shunt-limiting and medical treatments. Overall survival, lower-limb muscle strength, Fugl-Meyer score, Barthel index, and serum ammonia were recorded. Median survival time in group A or B was 30 months or 16.5 months, respectively (log rank p = 0.0172). All patients in group A obtained improvement in grading of muscle strength (p < 0.0001), Fugl-Meyer score (p = 0.0021), and Barthel index (p = 0.0003), particularly male patients and those subjected to shunt-limiting. Serum ammonia levels were decreased significantly in both group A (p = 0.0007) and group B (p = 0.0007). Collectively, once HM is confirmed after TIPS, active intervention is imperative and urgent, especially within the first 6 months from onset of symptom. TIPS shunt-limiting is particularly beneficial for rehabilitation in patients with early-onset HM.

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

“…For HM secondary to transjugular intrahepatic portosystemic shunt (TIPS) or surgical splenorenal shunt, reports have revealed that prompt shunt occlusion or shunt limitation may reverse HM[ 18 - 21 ]. Some studys have reported that shunt limitation, not shunt occlusion, is useful for reversing early-onset HM after TIPS[ 20 , 21 ]. Shunt limiting is preferred, as total shunt occlusion might have a higher risk of adverse events related to the rapid increase of portal hypertension.…”

Metabolic and Toxic Myelopathies

“…76,77 In patients who develop hepatic myelopathy after TIPS, endovascular occlusion of the TIPS may lead to clinical improvement. 71,78 Ammonia-lowering interventions that can treat hepatic encephalopathy (eg, lactulose, protein restriction) are generally ineffective.…”

“…Liver transplantation has been reported to lead to significant improvement and appears to be most effective when performed early in the course of the condition 76,77 . In patients who develop hepatic myelopathy after TIPS, endovascular occlusion of the TIPS may lead to clinical improvement 71,78 . Ammonia-lowering interventions that can treat hepatic encephalopathy (eg, lactulose, protein restriction) are generally ineffective.…”