Quick diagnosis of hepatic encephalopathy: Fact or fiction?

Montagnese, Sara; Schiff, Sami; Amodio, Piero

doi:10.1002/hep.27127

Cited by 11 publications

(13 citation statements)

References 5 publications

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“…While it is not realistic to suggest that such comprehensive evaluations are performed routinely, they should certainly be considered in patients with cirrhosis with neuropsychiatric impairment if: (i) blood ammonia levels are normal; (ii) there is no response to ammonia-lowering treatment; and (iii) there are possible alternative causes for the clinical findings Montagnese et al 2015).…”

Section: A Multimodal Approachmentioning

confidence: 98%

Qualifying and quantifying minimal hepatic encephalopathy

et al. 2015

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Minimal hepatic encephalopathy is the term applied to the neuropsychiatric status of patients with cirrhosis who are unimpaired on clinical examination but show alterations in neuropsychological tests exploring psychomotor speed/executive function and/or in neurophysiological variables. There is no gold standard for the diagnosis of this syndrome. As these patients have, by definition, no recognizable clinical features of brain dysfunction, the primary prerequisite for the diagnosis is careful exclusion of clinical symptoms and signs. A large number of psychometric tests/test systems have been evaluated in this patient group. Of these the best known and validated is the Portal Systemic Hepatic Encephalopathy Score (PHES) derived from a test battery of five paper and pencil tests; normative reference data are available in several countries. The electroencephalogram (EEG) has been used to diagnose hepatic encephalopathy since the 1950s but, once popular, the technology is not as accessible now as it once was. The performance characteristics of the EEG are critically dependent on the type of analysis undertaken; spectral analysis has better performance characteristics than visual analysis; evolving analytical techniques may provide better diagnostic information while the advent of portable wireless headsets may facilitate more widespread use. A large number of other diagnostic tools have been validated for the diagnosis of minimal hepatic encephalopathy including Critical Flicker Frequency, the Inhibitory Control Test, the Stroop test, the Scan package and the Continuous Reaction Time; each has its pros and cons; strengths and weaknesses; protagonists and detractors. Recent AASLD/EASL Practice Guidelines suggest that the diagnosis of minimal hepatic encephalopathy should be based on the PHES test together with one of the validated alternative techniques or the EEG. Minimal hepatic encephalopathy has a detrimental effect on the well-being of patients and their care-givers. It responds well to treatment with resolution of test abnormalities and the associated detrimental effects on quality of life, liver-related mortality and morbidity. Patients will only benefit in this way if they can be effectively diagnosed. Corporate efforts and consensus agreements are needed to develop effective diagnostic algorithms.

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Section: A Multimodal Approachmentioning

confidence: 98%

Qualifying and quantifying minimal hepatic encephalopathy

et al. 2015

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“…It cannot be done ''quick and simple'' but needs skilled and responsible evaluation of every finding indicating brain dysfunction in a patient with liver disease. The observation of competing causes of brain dysfunction in about 50 % of their patients made by Montagnese et al [49] indicates the need for a detailed diagnostic work up of the patients before a diagnosis of HE can be made. Most of the HE episodes are precipitated and can be treated by correction of the precipitating factor [61].…”

Section: Resultsmentioning

confidence: 97%

“…Recently, Montagnese et al [49] reported that in a series of 177 liver patients with clinically overt or subclinical signs of brain dysfunction 54 % had co-morbidities other than HE that could contribute to these alterations.…”

Section: Diagnosis Of Minimal Hementioning

confidence: 98%

Challenges in Diagnosing Hepatic Encephalopathy

Weißenborn

2014

Neurochem Res

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The term "hepatic encephalopathy" (HE) covers the neuropsychiatric syndrome associated with acute, chronic and acute-on-chronic liver disease (CLD). This paper deals with clinical features and diagnosis of HE in patients with liver cirrhosis and portal hypertension or porto-systemic shunts. The possible impact of concomitant disorders and the cirrhosis underlying liver disease upon brain function is described emphasizing the need of a detailed diagnostic work up of every individual case before diagnosing HE. Currently used methods for diagnosing minimal or covert hepatic encephalopathy are compared with regard to their sensitivity and specificity for diagnosing HE against the background of a multitude of concomitant disorders and diseases that could contribute to brain dysfunction.

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“…Since then, psychometric [3] and neurophysiological [4] abnormalities of various type and degree have been documented in apparently neuropsychiatrically normal patients with liver disease. In more recent years, the discussion has focused on whether these abnormalities are reversible (and thus a reflection of incompletely resolved overt HE [5,6]), whether they are an expression of HE or comorbidity [7], and whether they impact the quality of life and actual wellbeing of both patients and their caregivers [8][9][10]. However, the physicians' ability to define the impact of such abnormalities at an individual patient level remains limited, and when asked questions such as ''Can this patient drive?"…”

Section: Introductionmentioning

confidence: 99%