Open Access Subscription Access
Slowing of Alpha Waves on EEG, an Early Marker of Minimal Hepatic Encephalopathy
Introduction: Minimal Hepatic Encephalopathy (MHE) is the mildest form of spectrum of Hepatic Encephalopathy (HE) which remains undiagnosed due to lack of awareness. MHE has a negative effect on patient’s daily functioning due to cognitive impairment. Electro-Encephalo-Gram (EEG) and Mini Mental State Examination (MMSE) are useful in early diagnosis and follow up of MHE. Aim: To study evidence of MHE in patients with liver cirrhosis by psychometric tests and also its correlation with EEG changes. Materials and Methods: The study was carried out as a prospective case control study of 70 patients diagnosed with Cirrhosis of liver, over a period of two years in accordance with European Association for the Study of the Liver (EASL) and Asociacion Latinoamericana parael Estudio del Higado (ALEH) criteria with MMSE score >24 and were diagnosed as Minimal Hepatic Encephalopathy if 2 out of 3 psychometric tests were abnormal EEG was performed in them and was compared with 70 healthy controls. Results: Study showed male predominance (90%) with mean age of 45.49 ± 11.76. Alcohol related cirrhosis (70%) was found to be more common than HBV (8.57%) and HCV (2.86%) infection related cirrhosis. Pedal edema, icterus, pallor and ascites were the most common presenting manifestations. Most cirrhotic cases (80%) were under Child Pugh Class-A. On USG of abdomen all cases had Coarse echotexture and nodular surface of liver among them 11 cases had Hepatomegaly, 10 cases had splenomegaly, 42 cases had ascites and 24 cases had increased portal venous diameter of mean size 14.02 ± 0.48 mm. MMSE score of all selected cirrhotic cases was >24. Psychometric Tests i.e. Number Connection Test-A, Number Connection Test-B and Line tracing test were performed in all selected cirrhotic cases and they were not able to perform it within designated time. All cases were subjected to EEG and compared with equal number of comparable healthy controls, which shows change in frequency and amplitude of Alpha wave which was highly significant whereas no significant changes of frequency and amplitude of Beta, Theta and Delta waves between cases and controls. Conclusion: There is significant changes in alpha wave frequency and amplitude in patients with minimal hepatic encephalopathy.
Cirrhosis, Electro-Encephalo-Gram (EEG), Minimal Hepatic Encephalopathy, Psychometric Test.
- Ferenci P, Lockwood A, et al. Hepatic encephalopathy definition, nomenclature, diagnosis and quantification: final report of working party at the 11th word congresses of gastroenterology, Vienna, Hepatology. 2002; 35: 716-21. https://doi.org/10.1053/jhep.2002.31250. PMid:11870389.
- Prasad S, Dhiman RK, Duseja A, Chawla YK, et. al. Lactulose improves cognitive function and health related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy, Hepatology. 2007; 45:549-59. https://doi.org/10.1002/hep.21533. PMid:17326150.
- Sharma P, Sharma BC, Puri V, Sarin SK. Critical Flicker Frequency: Diagnostic tool for minimal hepatic encephalopathy, Journal of Hepatology. 2007; 47: 67-73 https://doi.org/10.1016/j.jhep.2007.02.022. PMid:17459511.
- Romero-Gomez M, Cordoba J, Jover R, et al. Valu of the critical flicker frequency in patients with minimal hepatic encephalopathy, Hepatology. 2007; 45:879-85. https://doi.org/10.1002/hep.21586. PMid: 17393525.
- Hartmann IJ, Groeneweg M, Quero JC, et al. The prognostic significance of subclinical hepatic encephalopathy, Am. J. Gastroenterol. 2000; 95:2029-34. https://doi.org/10.1111/j.1572-0241.2000.02265.x. PMid: 10950053.
- Groeneweg M, Quero JC, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW. Subclinical hepatic encephalopathy impairs daily functioning, Hepatology. 1998; 28:45-49. https://doi.org/10.1002/hep.510280108. PMid:9657095.
- Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic Encephalopathy - Definition, Nomenclature, Diagnosis, and Quantifcation: Final Report of the Working Party at the 11th World Congress of Gastroenterology, Vienna, 1998, Hepatology. 2002; 35:716-21. https://doi.org/10.1053/jhep.2002.31250. PMid:11870389.
- Zhan T, Stremmel W. The Diagnosis and Treatment of Minimal Hepati Encephalopathy, Deutsches Ärzteblatt International. 2012; 109(10):180-87. https://doi.org/10.3238/ arztebl.2012.0180. PMid:22470407, PMCid: PMC3317375.
- Praveen Sharma, Barjesh C. Sharma. A Survey of Patterns of Practice and Perception of Minimal Hepatic Encephalopathy: A Nationwide Survey in India, Saudi J. Gastroenterol. 2014 Sep-Oct; 20(5):304-08. https://doi.org/10.4103/1319-3767.141692. PMid: 25253366, PMCid: PMC4196346.
- EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis, Journal of Hepatology. 2015; 63(1):237-64. https://doi.org/10.1016/j.jhep.2015.04.006. PMid: 25911335.
- Dhiman R, Saraswat V, Sharma B, Sarin S, Chawla Y, Butterworth R, Duseja A, Aggarwal R, Amarapurkar D, Sharma P, Madan K, Shah S, Seth A, Gupta R, Koshy A, Rai R, Dilawari J, Mishra S, Acharya S. Minimal hepatic encephalopathy: Consensus statement of a working party of the Indian National Association for Study of the Liver, Journal of Gastroenterology and Hepatology. 2010; 25(6):1029-41. https://doi.org/10.1111/j.1440-1746.2010.06318.x. PMid:20594216.
- Wilson Stephanie R, Charboneau J. William, Leṿin Devorah. Diagnostic Ultrasound, Ed. by Carol M Rumack. 4rd edition. Philadelphia, PA: Elsevier/ Mosby, 2011. 2 v. xxii, 2031p. https://trove.nla.gov.au/version/227529277.
- Yu-Yuan Li, Yu-QiangNie, et al. Prevalence of subclinical hepatic encephalopathy in cirrhoticpatients in China, World J. Gastroenterol. August 15 2004; 10(16):2397-401. https://doi.org/10.3748/wjg.v10.i16.2397. PMid:15285027, PMCid:PMC4576296.
- Groeneweg M, QueroJ e, De Bruijn I, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW. Subclinical hepatic encephalopathy impaires daily functioning, Hepatology. 1998; 28:45-49. https://doi.org/10.1002/hep.510280108. PMid: 9657095.
- Wilsnack RW, Wilsnack SC, Kristjanson AF, VogeltanzHolm ND, Gmel G. Gender and Alcohol Consumption: Patterns from the Multinational Genacis Project, Addiction. (Abingdon, England). 2009; 104(9):1487-500. doi:https://doi.org/10.1111/j.1360-0443.2009.02696.x. PMid: 19686518, PMCid: PMC2844334.
- Schenker S, Balint J, SchiffL. Differential Diagnosis of Jaundice: Report of a Prospective Studies of 61 Proved Cases, Am. J. dif. Dis. 1962; 7:449-63. https://doi.org/10.1007/BF02232364. PMid: 13991584.
- Nakamura T, Nakamura S, Suzuki O, Aikawa T, Onodera A, Karoji N. Clinical studies of alcoholic hepatic disease, Tohoku J. ExpMed. 1967; 240:571-78.
- Ray R. The extent, pattern and trends of drug abuse in India. National Survey. United Nation Office on Drugs and Crime, New Delhi, 25 June 2004.
- Nadeem M, Yousaf MA, et al. The value of clinical signs in diagnosis of cirrhosis, Pak J. Med. Sci. 2005; 21(2):121-24.
- Quero JE, Hartmann IJ, Meulstee J, Hop WC, Schalm SW. The diagnosis of subclinical hepatic encephalopathy in patients with cirrhosis using neuropsychological test and automated electroencephalogram analysis, Hepatology. 1996; 24:556-60. https://doi.org/10.1002/hep.510240316. PMid:8781324.
- Giovanni D. De Palma, MD, Maria Rega, MD, Stefania Masone, MD, Francesco Persico, MD, Saverio Siciliano, MD, Francesco Patrone, MD, Luigi Matantuono, MD, Giovanni Persico, MD. Mucosal Abnormalities of the Small Bowel in Patients with Cirrhosis and Portal Hypertension: A Capsule Endoscopy Study, Gastrointestinal Endoscopy. October 2005; 62(4):529-34. https://doi.org/10.1016/S0016-5107(05)01588-9.
- Michela Corrias, Matteo Turco, Michele D. Rui. Angelo Gatta, Paolo Angeli, Carlo Merkel, Piero Amodio, Sarni Schiff, Sara Montagnese. Covert Hepatic Encephalopathy: Doesthe Mini-Mental State Examination Help? Journal of Clinical and Experimental. June 2014; 4(1):2189-93. https://doi.org/10.1016/j.jceh.2013.12.005. PMid:25755545, PMCid: PMC4116703.
- Groeneweg M, Moerland W, Quero JC, et al. Screening of subclinical hepatic encephalopathy, J. Hepatol. 2000; 32:74853. https://doi.org/10.1016/S0168-8278(00)80243-3.
- Weissenborn K, Ennen JC, Schomerus H, Rückert N, Hecker H. Review: Neuropsychological Characterization of Hepatic Encephalopathy, J. Hepatol. 2001; 34:768-73. https://doi.org/10.1016/S0168-8278(01)00026-5.
- Saxena N, Bhatia M, Joshi YK, Garg PK, Dwivedi SN, Tandon RK. Electrophysiological and Neuropsychological Tests for the Diagnosis of Subclinical Hepatic Encephalopathy and Prediction of Overt Encephalopathy, Liver. 2002; 22:190-97. https://doi.org/10.1034/j.1600-0676.2002.01431.x. PMid: 12100568.
- Amodio P, Marchetti P, Del Piccolo F, de Tourtchaninoff M,Varghese P, Zuliani C, Campo G, Gatta A, Guerit JM. Spectral Versus Visual EEG Analysis in Mild Hepatic Encephalopathy, Clin. Neurophysiol. 1999; 110:1334-344. https://doi.org/10.1016/S1388-2457(99)00076-0.
- Parsons-Smith BG, Summerskill WHJ, Dawson AM, Sherlock S. Theelectroencephalograph in liver disease, Lancet. 1957; 2:867-71. https://doi.org/10.1016/S0140-6736(57)90005-3.
- Weissenborn K. Diagnosis of Minimal Hepatic Encephalopathy, Journal of Clinical and Experimental Hepatology. 2015; 5(Suppl 1):S54-S59. doi: https://doi.org/10.1016/j.jceh.2014.06.005. PMid:26041959, PMCid:PMC4442856.
Abstract Views: 19
PDF Views: 0