Neurophysiological assessment of early hepatic encephalopathy

Weißenborn, Karin; Scholz, Michael; Hinrichs, H.; Wiltfang, Jens; Schmidt, F. W.; Künkel, Helmut

doi:10.1016/0013-4694(90)90107-u

Cited by 128 publications

(131 citation statements)

References 11 publications

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“…70,72 The use of P300 latency elicited by active auditory oddball paradigm was advocated as a tool to detect the onset of HE in several studies. 38,[73][74][75][76][77][78] Present knowledge supports the conclusion that in HE P300 latency is significantly more prolonged in HE then in normal subjects and, therefore the stimulus categorization time is prolonged. However, the value of P300 prolongation as a marker of the risk of the occurrence of overt HE in the follow up was found to be lower than that of the EEG (positive predictive value 53 vs. 75%, negative predictive value 81 vs. 86%).…”

Section: Motor Evoked Potentials (Meps)supporting

confidence: 85%

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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Section: Motor Evoked Potentials (Meps)supporting

confidence: 85%

Clinical Neurophysiology of Hepatic Encephalopathy

Amodio

Montagnese

2015

Journal of Clinical and Experimental Hepatology

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“…22,23 Recent studies have shown that P300 of auditory evoked potentials (AEPs) detects 30% of grade 0 PSE and 70% of grade 1 PSE. 13,24 Another study has shown that only 3 of 21 cirrhotic patients without PSE had increased P300 latency. 22 Another ERP, P300 of visual evoked potentials, has been reported to be more sensitive than psychometric tests in the assessment of subclinical PSE.…”

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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“…1 Nonetheless, adequate psychometric testing has been shown to have greater diagnostic sensitivity for MHE than neurophysiological tests, at least in some series. 14,15 Use of a combination of test methods is recommended to most reliably diagnose MHE. 1 Ammonia is a key factor in the pathogenesis of overt HE in cirrhotic patients, 16 and therapeutic interventions of proven benefit in this setting, such as treatment with lactulose (4-⌷-␤-d-galactopyranosyl-d-fructose), are generally aimed at reducing ammonia levels.…”

Section: Inimal Hepatic Encephalopathy (Mhe) In Pa-mentioning

confidence: 99%

Synbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis

Liu¹,

Duan²,

Ha³

et al. 2004

Hepatology

570

429

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Minimal hepatic encephalopathy (MHE) is an important disorder that may seriously impair daily functioning and quality of life in patients with cirrhosis. Treatment with lactulose is of benefit. The possible role of synbiotics (probiotics and fermentable fiber) has not been assessed. We screened 97 consecutive cirrhotic patients without overt hepatic encephalopathy for MHE using the number connection test and measurement of brainstem auditory evoked potentials. MHE, defined by abnormality on at least one test modality, was present in 58 (60%) patients. Fifty-five of these patients with MHE were randomized to receive a synbiotic preparation (n ‫؍‬ 20), fermentable fiber alone (n ‫؍‬ 20), or placebo (n ‫؍‬ 15) for 30 days. Cirrhotic patients with MHE were found to have substantial derangements in the gut microecology, with significant fecal overgrowth of potentially pathogenic Escherichia coli and Staphylococcal species. Synbiotic treatment significantly increased the fecal content of non-urease-producing Lactobacillus species at the expense of these other bacterial species. Such modulation of the gut flora was associated with a significant reduction in blood ammonia levels and reversal of MHE in 50% of patients. Synbiotic treatment was also associated with a significant reduction in endotoxemia. The Child-Turcotte-Pugh functional class improved in nearly 50% of cases. Treatment with fermentable fiber alone was also of benefit in a substantial proportion of patients. In conclusion, treatment with synbiotics or fermentable fiber is an alternative to lactulose for the management of MHE in patients with cirrhosis.

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Neurophysiological assessment of early hepatic encephalopathy

Cited by 128 publications

References 11 publications

Clinical Neurophysiology of Hepatic Encephalopathy

Clinical Neurophysiology of Hepatic Encephalopathy

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

Synbiotic modulation of gut flora: Effect on minimal hepatic encephalopathy in patients with cirrhosis

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