Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy

• Published in: Acta neurologica Scandinavica Vol. 122; no. 1; pp. 27 - 35
• Main Authors: Butz, M., Timmermann, L., Braun, M., Groiss, S. J., Wojtecki, L., Ostrowski, S., Krause, H., Pollok, B., Gross, J., Südmeyer, M., Kircheis, G., Häussinger, D., Schnitzler, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2010; Blackwell
• Subjects: Aged; Alcoholism - complications; ataxia; Ataxia - diagnosis; Ataxia - etiology; Biological and medical sciences; critical flicker frequency; Diseases of the nervous system; Dyskinesias - diagnosis; Dyskinesias - etiology; Female; Fingers - physiology; Functional Laterality; hepatic encephalopathy; Hepatic Encephalopathy - complications; Humans; Liver Cirrhosis - complications; Male; Medical sciences; metabolic disorder; Middle Aged; Neurology; neurophysiology; Neuropsychological Tests; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); tremor; Tremor - diagnosis; Tremor - etiology; Nervous system diseases; Tremor; Digestive system; Liver; Hepatic disease; Involuntary movement; Cerebral disorder; Cirrhosis; Metabolic disorder; Encephalopathy; Central nervous system disease; hepatic encephalopathy; Digestive diseases; Ataxia; critical flicker frequency; Neurological disorder; neurophysiology
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/j.1600-0404.2009.01246.x

Butz M, Timmermann L, Braun M, Groiss SJ, Wojtecki L, Ostrowski S, Krause H, Pollok B, Gross J, Südmeyer M, Kircheis G, Häussinger D, Schnitzler A. Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy.
Acta Neurol Scand: 2010: 122: 27–35.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard.
Aim –  Manifest hepatic encephalopathy (HE) goes along with motor symptoms such as ataxia, mini‐asterixis, and asterixis. The relevance of motor impairments in cirrhotics without and with minimal HE (mHE) is still a matter of debate.
Patients and methods –  We tested three different groups of patients with liver cirrhosis: no signs of HE (HE 0), mHE, and manifest HE grade 1 according to the West Haven criteria (HE 1). All patients (n = 24) and 11 healthy control subjects were neuropsychometrically tested including critical flicker frequency (CFF), a reliable measure for HE. Motor abilities were assessed using Fahn Tremor Scale and International Ataxia Rating Scale. Fastest alternating index finger movements were analyzed for frequency and amplitude.
Results –  Statistical analyses showed an effect of HE grade on tremor and ataxia (P < 0.01). Additionally, both ratings yielded strong negative correlation with CFF (P < 0.01, R = −0.5). Analysis of finger movements revealed an effect of HE grade on movement frequency (P < 0.03). Moreover, decreasing movement frequency and increasing movement amplitude parallel decreasing CFF (P < 0.01, R = 0.6).
Conclusion –  Our results indicate that ataxia, tremor, and slowing of finger movements are early markers for cerebral dysfunction in HE patients even prior to neuropsychometric alterations becoming detectable.