Postural control in patients with liver cirrhosis: a posturographic study.
BACKGROUND
Ataxia has been suggested in the literature to be a symptom of hepatic encephalopathy (HE), but so far has not been objectively quantified. In this study, we wanted to objectively quantify ataxia in patients with liver cirrhosis.


METHODS
One hundred and seven patients with liver cirrhosis were tested for postural control using posturography and compared with 25 controls. For quantification of HE, we used the number connection tests A and B, ammonia levels (NH3), and the partial pressure of ammonia in the arterial blood (pNH3).


RESULTS
Patients showed an impaired postural control compared with controls. Patients with Child C cirrhosis had lower scores in the posturography than those with Child A or B cirrhosis. Patients with alcohol-induced (AIC) Child B cirrhosis achieved lower scores in the posturography than those with non-alcohol-induced (NAIC) Child B cirrhosis. Patients with AIC Child C had lower scores than the corresponding NAIC patients, although this did not reach statistical significance. In the NAIC group Child C patients, in the AIC group Child B and C patients had lower scores than the controls. Patients with abnormal results in the number connection tests, as well as those with high NH3 and pNH3 levels showed worse postural control than those with normal results.


CONCLUSIONS
Patients with cirrhosis have an impaired postural control compared with controls and this impairment deteriorates with progression of liver disease. HE as well as past alcohol abuse contribute to the pathogenesis of ataxia in liver cirrhosis and past alcohol abuse leads to an earlier and more pronounced manifestation of ataxia in the affected patients.
Schmid
Monika
M
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Mittermaier
Christian
C
Voller
Bernhard
B
Fialka-Moser
Veronika
V
Gangl
Alfred
A
Peck-Radosavljevic
Markus
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000378:metabolism*; D001259:Ataxia / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
D000641:Ammonia