Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation.
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.
Joebges
E Michael
EM
Department of Neurology and Clinical Neurophysiology, Medizinische Hochschule, Hannover, Germany. jiebges@sachsenklinik.de
Heidemann
Melanie
M
Schimke
Nicole
N
Hecker
Hartmut
H
Ennen
Jochen C
JC
Weissenborn
Karin
K
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