title: Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation.
abstract: BACKGROUND
  One of the predominant symptoms of early stages of hepatic encephalopathy (HE) is bradykinesia.
  
  
  OBJECTIVE
  To further analyze the pathophysiology of bradykinesia in HE.
  
  
  METHODS
  A three-dimensional computer-assisted movement analysis was performed in 36 cirrhotics with grade 0-I HE compared to 18 controls selected with regard to sex and age and 16 patients with Parkinson's disease (PD). Four types of movement were studied: finger tapping, hand tapping, pronation/supination of the forearm and flexion/extension in the hip joint.
  
  
  RESULTS
  The patients with PD presented with a decrease of the maximal movement velocity (VMAX) and a prolongation of the time needed to reach VMAX (VTIME). In patients with minimal or grade I HE, the VMAX of all movements was unchanged compared to controls while the VTIME was significantly prolonged. This was caused by a delay before the beginning of each new part of the diadochokinetic movement cycle.
  
  
  CONCLUSIONS
  The data suggest an impairment of movement initiation as main cause of bradykinesia in early HE.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Medizinische Hochschule, Hannover, Germany. jiebges@sachsenklinik.de
authors.forename: E Michael
authors.initials: EM
authors.lastname: Joebges
authors.forename: Melanie
authors.initials: M
authors.lastname: Heidemann
authors.forename: Nicole
authors.initials: N
authors.lastname: Schimke
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Jochen C
authors.initials: JC
authors.lastname: Ennen
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
mesh_terms: D016022:Case-Control Studies; D001330:Electronic Data Processing; D005260:Female; D005385:Fingers / Q000503:physiopathology; D005542:Forearm / Q000503:physiopathology; D006225:Hand / Q000503:physiopathology; D006501:Hepatic Encephalopathy / Q000150:complications*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D018476:Hypokinesia / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009068:Movement; D010300:Parkinson Disease / Q000503:physiopathology; D013997:Time Factors