Comparison of Lactulose and Neomycin in the Treatment of Chronic Portal-Systemic Encephalopathy

Conn, Harold O.; Leevy, Carroll M.; Vlahčevič, Z. Reno; Rodgers, Joseph T.; Maddrey, Willis C.; Seeff, Leonard B.; Levy, Lester M.

doi:10.1016/s0016-5085(77)80135-2

Cited by 604 publications

(229 citation statements)

References 22 publications

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“…Hepatic failure (HF) was considered present when there were ascites, hypoalbuminemia, jaundice and prolonged prothrombin time (>3 sec). Clinical grading of HE was semiquantified as Grades 1 to 4, based primarily on the criteria of Conn et al (17) and determined prior to the BAEP testing. In Grade 1 HE, the patients were confused or had altered mood or behavior; in Grade 2 HE, the patients were markedly confused, drowsy or had inappropriate behavior.…”

Section: Methodsmentioning

confidence: 99%

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Brainstem auditory evoked potentials in hepatic encephalopathy

1986

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Brainstem auditory evoked potentials were obtained from 30 patients primarily with viral hepatitis to determine the functional status of the brainstem in hepatic encephalopathy. The patients were divided into four groups: Group 1 with compensated hepatic diseases; Group 2 with hepatic failure but no hepatic encephalopathy; Group 3 with Grade 1 or 2 hepatic encephalopathy, and Group 4 with Grade 3 or 4 hepatic encephalopathy. The brainstem auditory evoked potential central conduction times (I-V interval) of four patient groups were not significantly different from that of the age-matched control group. The present data suggest that the brainstem auditory pathways remain undisturbed in hepatic encephalopathy.

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Section: Methodsmentioning

confidence: 99%

“…Twenty-eight of the 30 patients and 12 of the 20 control subjects had conventional EEGs taken within 4 hr of the BAEP testing. The classification of EEG findings was based on the frequency changes proposed by Conn et al (17). An EEG with dominant frequency less than 8 cycles per sec was defined as abnormal.…”

Section: Sepbmentioning

confidence: 99%

Brainstem auditory evoked potentials in hepatic encephalopathy

1986

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“…(13) Performance was classified as impaired if the sum of the standard deviations for the individual tests, referred to as the Psychometric Hepatic Encephalopathy Score (PHES), was -4 (12,13) ; the mean of the z scores for each subtest (MPZS) (13) was also used for purposes of correlation analysis as it is both a slightly more accurate (average z score rather than sum of the rounded z integers), symmetrically distributed and more continuous index. (13) NEUROPSYCHIATRIC STATUS Neuropsychiatric status on the day of study was classified as unimpaired: no clinical evidence of HE and normal PHES; covert HE: no obvious clinical abnormal-ities but abnormal PHES; overt HE: clinically evident neuropsychiatric disturbances (grade 2 according to the West Haven criteria (3) applied by authors M.D.R., S.M., and P.Am., and/or asterixis (14) ).…”

Section: Neuropsychological Assessmentmentioning

confidence: 99%

“…on visual estimates of the slowing of the EEG. (3) This was later modified to automatically obtain a set of parameters defining the EEG frequency by means of an automated analysis of the digitized tracing (spectral analysis). (4) This classification has been proven to be more objective and more reliable compared to visual assessment.…”

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confidence: 99%

A low‐cost, user‐friendly electroencephalographic recording system for the assessment of hepatic encephalopathy

Schiff

Casa

et al. 2016

Hepatology

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Electroencephalography (EEG) is useful to objectively diagnose/grade hepatic encephalopathy (HE) across its spectrum of severity. However, it requires expensive equipment, and hepatogastroenterologists are generally unfamiliar with its acquisition/interpretation. Recent technological advances have led to the development of low-cost, user-friendly EEG systems, allowing EEG acquisition also in settings with limited neurophysiological experience. The aim of this study was to assess the relationship between EEG parameters obtained from a standard-EEG system and from a commercial, low-cost wireless headset (light-EEG) in patients with cirrhosis and varying degrees of HE. Seventy-two patients (58 males, 61 6 9 years) underwent clinical evaluation, the Psychometric Hepatic Encephalopathy Score (PHES), and EEG recording with both systems. Automated EEG parameters were calculated on two derivations. Strong correlations were observed between automated parameters obtained from the two EEG systems. Bland and Altman analysis indicated that the two systems provided comparable automated parameters, and agreement between classifications (normal versus abnormal EEG) based on standard-EEG and light-EEG was good (0.6 < j < 0.8). Automated parameters such as the mean dominant frequency obtained from the light-EEG correlated significantly with the Model for End-Stage Liver Disease score (r 5 20.39, P < 0.05), fasting venous ammonia levels (r 5 20.41, P < 0.01), and PHES (r 5 20.49, P < 0.001). Finally, significant differences in light-EEG parameters were observed in patients with varying degrees of HE. Conclusion: Reliable EEG parameters for HE diagnosing/ grading can be obtained from a cheap, commercial, wireless headset; this may lead to more widespread use of this patientindependent tool both in routine liver practice and in the research setting. (HEPATOLOGY 2016;63:1651-1659 H epatic encephalopathy (HE) is a neuropsychiatric syndrome caused by liver disease and/or portal-systemic shunting, which manifests as a wide spectrum of mental and motor dysfunction.Patients with cirrhosis and HE exhibit electroencephalographic (EEG) alterations. These were first identified in 1950 by Foley and colleagues, who described highvoltage, slow waves in patients with hepatic coma.(1) A few years later, Parsons-Smith and colleagues reported that EEG alterations in patients with cirrhosis were related to the severity of overt HE (i.e., the more severe the clinical picture, the slower the EEG).(2) The same authors highlighted how mild EEG slowing could also be detected in patients without overt HE, thus already introducing the concept of latent or subclinical HE.(2) The visual classification of EEG changes proposed by ParsonsSmith and colleagues was descriptive in nature and thus prone to interobserver variability. In 1977, Conn and coworkers proposed a semiquantitative classification based Abbreviations: EEG, electroencephalography; HE, hepatic encephalopathy; MDF, mean dominant frequency; MELD, Model for End-Stage Liver Disease; MPZS, mean PHES z ...

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“…As discussed in detail, the so-called overt form of HE was divided into four stages of severity based on the New Haven scale devised by Harold Conn and colleagues. 5 This was quite satisfactory for stages 2-4, but most clinicians had great difficulty in Table 4). The spectrum of neurological impairment seen in cirrhotic patients (SONIC) 6 has been adapted to either show a spectrum extending from normality to minimal to the four stages of overt HE or the spectrum showing covert HE, which is essentially the amalgamation of stage 1 HE and minimal HE.…”

mentioning

confidence: 93%

Nomenclature and definition of hepatic encephalopathy — An update

Allampati

Mullen

2015

Clinical Liver Disease

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As recently as the mid-1990s, nomenclature and definitions for hepatic encephalopathy (HE) were not standardized. Many opinions prevailed, but hardly any consensus was present. Journal articles were being turned down based on incorrect terminology despite no real agreement on this issue in the liver community and the even more rarefied hepatic encephalopathy research community. A survey on what people thought the terms acute and chronic HE indicated was sent to 52 possible experts in the field of HE before and during an ISHEN meeting in Newcastle held in 1996. The results of the survey are shown in Table 1.Preliminary work before that meeting prepared the audience for adoption of some new terms. The survey results, as noted above, were notable for very widespread opinions on what the terms acute and chronic HE actually signified. Alas, the impact of that workshop was severely curtailed by the omission in the Newcastle proceedings book of any report on this topic. One issue was very clearly resolved. Dame Sheila Sherlock attended the Newcastle meeting and officially approved the adoption of the term hepatic encephalopathy over portosystemic or portal-systemic encephalopathy. Joseph Foley and Monroe Cole, previous active contributors to HE literature who resided in Cleveland, Ohio, also subsequently endorsed the change in the name of the syndrome.

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Comparison of Lactulose and Neomycin in the Treatment of Chronic Portal-Systemic Encephalopathy

Cited by 604 publications

References 22 publications

Brainstem auditory evoked potentials in hepatic encephalopathy

Brainstem auditory evoked potentials in hepatic encephalopathy

A low‐cost, user‐friendly electroencephalographic recording system for the assessment of hepatic encephalopathy

Nomenclature and definition of hepatic encephalopathy — An update

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