Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy.
OBJECTIVE
Manifest hepatic encephalopathy (HE) goes along with motor symptoms such as ataxia, mini-asterixis, and asterixis. The relevance of motor impairments in cirrhotics without and with minimal HE (mHE) is still a matter of debate.


METHODS
We tested three different groups of patients with liver cirrhosis: no signs of HE (HE 0), mHE, and manifest HE grade 1 according to the West Haven criteria (HE 1). All patients (n = 24) and 11 healthy control subjects were neuropsychometrically tested including critical flicker frequency (CFF), a reliable measure for HE. Motor abilities were assessed using Fahn Tremor Scale and International Ataxia Rating Scale. Fastest alternating index finger movements were analyzed for frequency and amplitude.


RESULTS
Statistical analyses showed an effect of HE grade on tremor and ataxia (P < 0.01). Additionally, both ratings yielded strong negative correlation with CFF (P < 0.01, R = -0.5). Analysis of finger movements revealed an effect of HE grade on movement frequency (P < 0.03). Moreover, decreasing movement frequency and increasing movement amplitude parallel decreasing CFF (P < 0.01, R = 0.6).


CONCLUSIONS
Our results indicate that ataxia, tremor, and slowing of finger movements are early markers for cerebral dysfunction in HE patients even prior to neuropsychometric alterations becoming detectable.
Butz
M
M
Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany. markus.butz@uni-duesseldorf.de <markus.butz@uni-duesseldorf.de>
Timmermann
L
L
Braun
M
M
Groiss
S J
SJ
Wojtecki
L
L
Ostrowski
S
S
Krause
H
H
Pollok
B
B
Gross
J
J
Südmeyer
M
M
Kircheis
G
G
Häussinger
D
D
Schnitzler
A
A
D000368:Aged; D000437:Alcoholism / Q000150:complications; D001259:Ataxia / Q000175:diagnosis / Q000209:etiology; D020820:Dyskinesias / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005385:Fingers / Q000502:physiology; D007839:Functional Laterality; D006501:Hepatic Encephalopathy / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014202:Tremor / Q000175:diagnosis / Q000209:etiology