Current trends in the treatment of hepatic encephalopathy

Sibae, Mohamad Rasm Al; McGuire, Brendan M.

doi:10.2147/tcrm.s4443

Cited by 30 publications

(10 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Metronidazole is occasionally in the management of hepatic encephalopathy, or for treatment of intercurrent infections in patients with liver disease. 126 Patients receiving metronidazole may develop a syndrome characterized by ataxia, cerebellar dysarthria, neuropathy and occasionally, encephalopathy. 127 , 128 Toxicity can result either from high‐dose or cumulative low dose exposure.…”

Section: Combined Movement Disorders and Hepatic Disease Secondary To Toxic/iatrogenic Causesmentioning

confidence: 99%

Movement Disorders and Liver Disease

Mulroy

Baschieri

Magrinelli

et al. 2021

Movement Disord Clin Pract

View full text Add to dashboard Cite

The association of movement disorders with structural or functional hepatic disease occurs in three principal scenarios: (1) combined involvement of both organ systems from a single disease entity, (2) nervous system dysfunction resulting from exposure to toxic compounds in the setting of defective hepatic clearance, or (3) hepatic and/or neurological injury secondary to exposure to exogenous drugs or toxins. An important early step in the workup of any patient with combined movement disorders and liver disease is the exclusion of Wilson's disease. Diagnostic delay remains common for this treatable disorder, and this has major implications for patient outcomes. Thereafter, a structured approach integrating variables such as age of onset, tempo of progression, nature and severity of liver involvement, movement disorder phenomenology, exposure to drugs/toxins and laboratory/neuroimaging findings is key to ensuring timely diagnosis and disease-specific therapy. Herein, we provide an overview of disorders which may manifest with a combination of movement disorders and liver disease, structured under the three headings as detailed above. In each section, the most common disorders are discussed, along with important clinical pearls, suggested diagnostic workup, differential diagnoses and where appropriate, treatment considerations.The association of movement disorders (MD) with hepatic disease is a noteworthy one. In some instances, it is merely coincidental. In others, it may reflect:

show abstract

Section: Combined Movement Disorders and Hepatic Disease Secondary To Toxic/iatrogenic Causesmentioning

confidence: 99%

Movement Disorders and Liver Disease

Mulroy

Baschieri

Magrinelli

et al. 2021

Movement Disord Clin Pract

View full text Add to dashboard Cite

show abstract

“…Finally, the presence of precipitating factors leads to the classification of: spontaneous and precipitated. The main HE precipitating factors are: infections, electrolyte disorder, gastrointestinal bleeding, diuretic overdose, excessive protein intake, diarrhea, hypoxia, peripheral vasodilatation, dehydration, among others (Al Sibae and McGuire, 2009). HE pathogenesis is not well-understood, although it is suspected to involve the action of neurotoxins, such as excessive production of ammonia from the liver, by decreasing its metabolism.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cognitive Impairment After Resolution of Hepatic Encephalopathy: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Hepatic encephalopathy (HE) is one of the most disabling metabolic diseases. It consists of a complication of liver disease through the action of neurotoxins, such as excessive production of ammonia from liver, resulting in impaired brain function. Its prevalence and incidence are not well known, although it has been established that up to 40% of cirrhotic patients may develop HE. Patients with HE episodes display a wide range of neurological disturbances, from subclinical alterations to coma. Recent evidence suggests that the resolution of hepatic encephalopathy does not fully restore cognitive functioning in cirrhotic patients. Therefore, the aim of this review was to evaluate the evidence supporting the presence of lingering cognitive deficits in patients with a history of HE compared to patients without HE history and how liver transplant affects such outcome in these patients. We performed two distinct meta-analysis of continuous outcomes. In both cases the results were pooled using random-effects models. Our results indicate that cirrhotic patients with a history of HE show clear cognitive deficits compared control cirrhotic patients (Std. Mean Difference (in SDs) = −0.72 [CI 95%: −0.94, −0.50]) and that these differences are not fully restored after liver transplant (Std. Mean Difference (in SDs) = −0.72 [CI 95%: −0.94, −0.50]).

show abstract

“…Interestingly, the parent aminoglycoside, neomycin was also able to inhibit miR-525 biogenesis in HCC cells. Since neomycin B is already used clinically to treat hepatic encephalopathy,(478) this study suggests that neomycin B or Neo-N 3 could be used at low doses to work synergistically with HCC therapeutics.…”

Section: Small Molecules Targeting Nucleic Acid Sequencementioning

confidence: 94%

Using Genome Sequence to Enable the Design of Medicines and Chemical Probes

et al. 2018

View full text Add to dashboard Cite

Rapid progress in genome sequencing technology has put us firmly into a postgenomic era. A key challenge in biomedical research is harnessing genome sequence to fulfill the promise of personalized medicine. This Review describes how genome sequencing has enabled the identification of disease-causing biomolecules and how these data have been converted into chemical probes of function, preclinical lead modalities, and ultimately U.S. Food and Drug Administration (FDA)-approved drugs. In particular, we focus on the use of oligonucleotide-based modalities to target disease-causing RNAs; small molecules that target DNA, RNA, or protein; the rational repurposing of known therapeutic modalities; and the advantages of pharmacogenetics. Lastly, we discuss the remaining challenges and opportunities in the direct utilization of genome sequence to enable design of medicines.

show abstract

Current trends in the treatment of hepatic encephalopathy

Cited by 30 publications

References 52 publications

Movement Disorders and Liver Disease

Movement Disorders and Liver Disease

Cognitive Impairment After Resolution of Hepatic Encephalopathy: A Systematic Review and Meta-Analysis

Using Genome Sequence to Enable the Design of Medicines and Chemical Probes

Contact Info

Product

Resources

About