Reversal of hepatic myelopathy after liver transplantation: Fifteen plus one

Baccarani, F.E.B.S. Umberto; Zola, E.; Adani, Gian Luigi; Cavalletti, Matteo; Schiff, Sami; Cagnin, Annachiara; Poci, C.; Merkel, Carlo; Amodio, Piero; Montagnese, Sara

doi:10.1002/lt.22149

Cited by 25 publications

(14 citation statements)

References 6 publications

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“…Hepatic myelopathy (HM) is a particular pattern of HE possibly related to marked, long‐standing portocaval shunting, characterized by severe motor abnormalities exceeding the mental dysfunction. Cases of paraplegia with progressive spasticity and weakness of lower limbs with hyper‐reflexia and relatively mild persistent or recurrent mental alterations have been reported and do not respond to standard therapy, including ammonia lowering, but may reverse with liver transplantation (LT) …”

Section: Definition Of the Disease/conditionmentioning

confidence: 99%

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

et al. 2014

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Section: Definition Of the Disease/conditionmentioning

confidence: 99%

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

et al. 2014

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“…It is possible that Hepatic myelopathy is a risk factor for HE or a non-behavioral dimension of the same syndrome, but this requires further investigation. [53][54][55][56][57] Somatosensory evoked potentials (SSEPs) SSEPs explore both nervous transmission from the medulla oblongata to the cortex (central conduction timei.e., the interpeak latency N13-N20-) and hemispheric transmission (middle components of the EP), therefore produce data related to the ones provided by BAEPs and fVEPs, respectively. A minor prolongation of central conduction time in cirrhosis, 37,58 and therefore an alteration in brainstem nervous transmission possibly due to myelopathy or edema was confirmed by SSEPs.…”

Section: Brainstem Auditory Evoked Potentials (Baeps)mentioning

confidence: 99%

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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“…Independent of the problem of how to weight HE for transplantation priority ranking, it is clear that HE is a marker of poor survival and patients with HE should be referred to a hepatology transplant centre to be evaluated. In addition, patients with the rare variety of HE characterised by prominent motor alterations (hepatic myelopathy) will benefit greatly from transplantation …”

Section: Hepatic Encephalopathy and Liver Transplantationmentioning

confidence: 99%

Hepatic encephalopathy: Diagnosis and management

Amodio

2018

Liver International

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Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. The prognosis of HE is important in terms of survival and re-hospitalisation. It is related to impaired quality of life, falls and poor driving; presents a relevant burden for caregivers and health services; and may negatively impact on patient's job and income. Proper diagnosis and classification are expected to improve HE management. Once diagnosed, the management and therapeutic options for HE are generally clear. The improvement of knowledge in recent years has also clarified which are the further aims of research in this field of medicine. Prophylaxis of overt HE should always be performed, and this is generally secondary prophylaxis. Primary prophylaxis should be done immediately after upper gastrointestinal bleeding. Great advances in the detection and treatment of mild forms of HE are expected to lead to further improvement in patient management.

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Reversal of hepatic myelopathy after liver transplantation: Fifteen plus one

Cited by 25 publications

References 6 publications

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study Of Liver Diseases and the European Association for the Study of the Liver

Clinical Neurophysiology of Hepatic Encephalopathy

Hepatic encephalopathy: Diagnosis and management

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