title: Cirrhosis-related Parkinsonism: prevalence, mechanisms and response to treatments.
abstract: OBJECTIVE
  Extrapyramidal and cerebellar symptoms belong to the most prominent features of episodic hepatic encephalopathy, and usually decrease upon ammonia-lowering therapy. Rapidly progressing parkinsonian symptoms, which are unresponsive to treatment of hepatic encephalopathy, indicate cirrhosis-related Parkinsonism. This study aims at analyzing the prevalence of cirrhosis-related Parkinsonism in patients with liver cirrhosis, and to study the functional status of the striatal dopaminergic system in these patients.
  
  
  METHODS
  214 patients with liver cirrhosis who were consecutively seen at the out-patient clinic for liver transplant candidates and/or at the transplantation wards at Hannover Medical School, between August 1, 2008 and March 31, 2011, underwent a standardized neurological examination while on the waiting list or immediately after liver transplantation. Single photon emission computer tomography (SPECT) using (123)I-beta-CIT, for the evaluation of the striatal dopamine transporter function, and (123)I-IBZM for the evaluation of the striatal dopamine D2 receptor availability, was performed in 6 patients with cirrhosis-related Parkinsonism.
  
  
  RESULTS
  Cirrhosis-related Parkinsonism was diagnosed in 9 of 214 patients (4.2%). SPECT revealed significantly decreased dopamine receptor availability in 5 of 6 patients studied, and significantly decreased dopamine transporter availability in 3. Levodopa improved motor dysfunction in two of four patients treated, although only temporarily. Incomplete recovery was observed in two patients after liver transplantation.
  
  
  CONCLUSIONS
  Cirrhosis-related Parkinsonism is more frequent than presumed. The presented data suggest pre- and postsynaptic alteration of striatal dopaminergic neurotransmission as a possible cause of cirrhosis-related Parkinsonism and reveal the limited effects of dopaminergic therapy.
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany.
authors.forename: Anita B
authors.initials: AB
authors.lastname: Tryc
authors.forename: Annemarie
authors.initials: A
authors.lastname: Goldbecker
authors.forename: Georg
authors.initials: G
authors.lastname: Berding
authors.forename: Stefan
authors.initials: S
authors.lastname: Rümke
authors.forename: Kambiz
authors.initials: K
authors.lastname: Afshar
authors.forename: Golschan Hamidi
authors.initials: GH
authors.lastname: Shahrezaei
authors.forename: Henning
authors.initials: H
authors.lastname: Pflugrad
authors.forename: Hannelore
authors.initials: H
authors.lastname: Barg-Hock
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
mesh_terms: D000328:Adult; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000503:physiopathology; D004298:Dopamine / Q000502:physiology; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D017448:Receptors, Dopamine D2 / Q000502:physiology; D009435:Synaptic Transmission; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: C581293:DRD2 protein, human; D017448:Receptors, Dopamine D2; D004298:Dopamine