title: Diagnostic value of fine motor deficits in patients with low-grade hepatic encephalopathy.
abstract: OBJECTIVE
  The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.
  
  
  METHODS
  A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.
  
  
  RESULTS
  Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy.
  
  
  CONCLUSIONS
  The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.
authors.affiliation: Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. s.mechtcheriakov@uibk.ac.at
authors.forename: Sergei
authors.initials: S
authors.lastname: Mechtcheriakov
authors.forename: Ivo W
authors.initials: IW
authors.lastname: Graziadei
authors.forename: Maria
authors.initials: M
authors.lastname: Rettenbacher
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schuster
authors.forename: Hartmann
authors.initials: H
authors.lastname: Hinterhuber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
authors.forename: Josef
authors.initials: J
authors.lastname: Marksteiner
mesh_terms: D000328:Adult; D000368:Aged; D001154:Art; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006236:Handwriting; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D010865:Pilot Projects