Brainstem auditory evoked potentials in hepatic encephalopathy

Yang, Sien–Sing; Chu, Nai‐Shin; Liaw, Yun–Fan

doi:10.1002/hep.1840060622

Cited by 34 publications

(5 citation statements)

References 26 publications

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“…Chu and Yang (30) have shown that the late cortical components of somatosensory evoked potentials are affected by preclinical and clinical encephalopathy. They have further shown that hepatic dysfunction without cirrhosis whether or not due to alcohol ingestion will not produce these changes (3,31,32). The comparison of the nonalcoholic and alcoholic cirrhotics in this study would confirm the impression that the findings are not solely a result of alcohol ingestion.…”

Section: Discussionsupporting

confidence: 82%

The auditory P300 event—related potential: An objective marker of the encephalopathy of chronic liver disease

et al. 1990

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Recently many variants of electroencephalogram-evoked responses have been studied as potential diagnostic aids in the detection and evaluation of hepatic encephalopathy. This study assesses the value of the auditory P300 event-related potential--a slow component of the auditory evoked response--as a tool in this field. Twenty-one nonencephalopathic and 12 encephalopathic (grade 1/2) cirrhotic patients and 26 controls were assessed clinically and psychometrically. Electroencephalogram spectral analysis and visual evoked response recordings were also conducted. An auditory P300 wave was elicited using the standard two-tone discrimination paradigm. The latency and amplitude of this wave were measured. The latency of the P300 was found to be significantly increased in the encephalopathic patients compared with both nonencephalopathic cirrhotic and control groups (p less than 0.05). Amplitude of the wave was decreased in both nonencephalopathic and encephalopathic patients, but this was not statistically significant. This study suggests that the latency of the P300 is a good marker of grades 1 and 2 clinical hepatic encephalopathy. The delays in the P300 latency may indicate that encephalopathic patients have a deterioration of their stimulus evaluation abilities.

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Section: Discussionsupporting

confidence: 82%

The auditory P300 event—related potential: An objective marker of the encephalopathy of chronic liver disease

et al. 1990

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“…59 These findings prove that HE influences hemispheric multisynaptic pathways more than subcortical brainstem neurotransmission. 34,[60][61][62] The same findings were confirmed in HE of acute liver failure: the disappearance of the middle latency cortical component (e.g., N70) precedes that of the earlier components (e.g., N20 and P25) and the increase of central conduction time. However, the delay of middle latency cortical components of SSEPs was found to be less sensitive than that of the cognitive evoked potential P300 in the model of HE caused by TIPS insertion, 63 and no comparison with the EEG was produced for this indication.…”

Section: Brainstem Auditory Evoked Potentials (Baeps)supporting

confidence: 53%

Clinical Neurophysiology of Hepatic Encephalopathy

Amodio

Montagnese

2015

Journal of Clinical and Experimental Hepatology

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Background/Objectives: Hepatic encephalopathy (HE) has relevant impact on the quality of life of patients and their caregivers and causes relevant costs because of hospitalizations and work days lost. Its quantification is important to perform adequate clinical trials on this relevant complication of cirrhosis and portal-systemic shunting. Clinical neurophysiology, which detects functional alterations of the nervous system, has been applied to the study of HE for over 60 years. This review aims at summarizing and clarifying the role of neurophysiologic techniques in the study of HE. Methods: A narrative review was performed aiming at interpreting the cited papers and the techniques on the basis of their physiological and pathophysiological meaning. Results: The potential role of EEG, quantified EEG, evoked potentials-both exogenous, endogenous and motor-have been clarified to the reader that may be unfamiliar with neurophysiology. Conclusions: The EEG, reflecting the oscillatory changes of neural network is the preferable tool to detect and monitor HE, with the exception of its most severe stage, when EEG flattens. SSEP and MEP have indication to detect and monitor transmission alterations that are likely related to myelin changes and microedema. ( J CLIN EXP HEPATOL 2014;5:S60-S68)

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“…Higher intensities of 70 to 80 dB were sometimes needed to elicit responses. 28 ERPs are therefore not suitable for patients with severe HE who are unlikely to follow instructions. Factors such as age, task difficulty, and compliance of the subjects can also affect the latency of P300 of AEP and visual evoked potentials.…”

Section: Discussionmentioning

confidence: 99%

Somatosensory evoked potentials in subclinical portosystemic encephalopathy: A comparison with psychometric tests

Yang

Chiang

et al. 1998

Hepatology

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We prospectively studied the role of somatosensory evoked potentials (SEPs) and psychometric tests in the assessment of subclinical portosystemic encephalopathy (PSE) Evoked potentials are noninvasive, objective electrical manifestations of the nervous system function in response to stimulation. 3,4 Somatosensory evoked potentials (SEPs) can detect the integrity of somatosensory pathways from the peripheral to the central nervous system. 3,4 SEPs are useful in the objective assessment and monitoring of HE in a variety of liver diseases. 5,6 In HE, median nerve-stimulated SEPs showed a progressive prolongation of N20-N65 interpeak latencies (IPLs) correlating with the severity of HE. 6 N20-N65 IPLs have been used in the clinical monitoring of HE, evaluation of the treatment for HE, and prediction of prognosis. [7][8][9][10] In acute and chronic liver disease, approximately one half of the patients with decompensated liver function with grade 0 HE had abnormal prolongation of N20-N65 interpeak latencies. 6,11,12 It is likely that SEP can be of value in the detection of subclinical HE. 13 Therefore, we studied and compared the roles of SEPs and psychometric tests in detection of subclinical HE in cirrhotic patients. PATIENTS AND METHODS Subjects.One hundred consecutive documented cases of cirrhotic patients without clinical HE were studied prospectively at the Cathay General Hospital between 1994 and 1996. Twenty healthy volunteers served as controls. An additional 6 uneducated healthy volunteers underwent only psychometric tests. Sixty-five cirrhotic patients (hepatitis B virus, 30; hepatitis C virus, 28; hepatis B virus and hepatitis C virus, 2; hepatitis B virus and hepatitis D virus, 2; cryptogenic, 3) were included in the present study. Thirty-five cirrhotic patients were excluded because of serious complications and incomplete study. Cirrhosis was diagnosed when patients developed chronic hepatitis with serum alanine transamine (ALT) levels higher than 1.5 times the upper normal limit (normal ALT activity, Ͻ35 IU/L) over a period of more than 6 months, sonographic findings of small liver as well as splenomegaly, and moderate or severe degrees of esophageal varices proven by upper endoscopy.Cirrhotic patients with grade 0 HE were included in the present study. Patients with other neurological diseases and metabolic disorders such as alcoholism, diabetes mellitus, or end-stage renal disease were excluded to avoid coexistent neuropathy or other brain dysfunction. Patients with fever, sepsis, or shock were also excluded to avoid variations caused by body temperature. All cirrhotic patients underwent blood tests, tests for grading of HE and degree of asterixis, psychometric tests, electroencephalography (EEG), and SEPs.Hepatic Encephalopathy. The degree of HE was semiquantified as grade 1 to 4, based on the mental changes proposed by Conn et al. 2 immediately before SEP testing.Blood Tests. Peripheral blood was collected after overnight fasting and within 12 hours of SEP testing for biochemistry at a central lab...

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Brainstem auditory evoked potentials in hepatic encephalopathy

Cited by 34 publications

References 26 publications

The auditory P300 event—related potential: An objective marker of the encephalopathy of chronic liver disease

The auditory P300 event—related potential: An objective marker of the encephalopathy of chronic liver disease

Clinical Neurophysiology of Hepatic Encephalopathy

Somatosensory evoked potentials in subclinical portosystemic encephalopathy: A comparison with psychometric tests

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