title: Spectral electroencephalogram in liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy.
abstract: OBJECTIVE
  Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy. Spectral electroencephalogram (sEEG) analysis improves the recognition of MHE by decreasing inter-operator variability and providing quantitative parameters of brain dysfunction. We compared sEEG in patients with cirrhosis with and without MHE and the effects of lactulose on sEEG in patients with MHE.
  
  
  METHODS
  One hundred patients with cirrhosis (50 with and 50 without MHE) were enrolled. Diagnosis of MHE was based on psychometric hepatic encephalopathy score (PHES) of ≤ -5. Critical flicker frequency, model of end-stage liver disease score, and sEEG were performed at baseline in all patients. The spectral variables considered were the mean dominant frequency (MDF) and relative power in beta, alpha, theta, and delta bands. Patients with MHE were given 3 months of lactulose, and all parameters were repeated.
  
  
  RESULTS
  Spectral electroencephalogram analysis showed lower MDF (7.8 ± 1.7 vs 8.7 ± 1.3 Hz, P < 0.05) and higher theta relative power (34.29 ± 4.8 vs 24 ± 6.7%, P = 001) while lower alpha relative power (28.6 ± 4.0 vs 33.5 ± 5.3%, P = .001) in patients with MHE than in patients without MHE. With theta relative power, sensitivity 96%, specificity 84%, and accuracy of 90% were obtained for diagnosis of MHE. After lactulose treatment, MHE improved in 21 patients, and significant changes were seen in MDF (7.8 ± 0.5 vs 8.5 ± 0.6), theta (34.2 ± 4.8 vs 23.3 ± 4.1%), alpha (28.6 ± 4.0 vs 35.5 ± 4.5%), and delta relative power (13.7 ± 3.5 vs 17.0 ± 3.3%) after treatment (P ≤ 0.05).
  
  
  CONCLUSIONS
  Spectral EEG is a useful objective and quantitative tool for diagnosis and to assess the response to treatment in patients with cirrhosis with MHE.
authors.affiliation: Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
authors.forename: Jatinderpal
authors.initials: J
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Maharshi
authors.affiliation: Department of Neurology, G. B. Pant Hospital, New Delhi, India.
authors.forename: Vinod
authors.initials: V
authors.lastname: Puri
authors.affiliation: Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D001921:Brain / Q000187:drug effects* / Q000503:physiopathology; D016022:Case-Control Studies; D004569:Electroencephalography; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011594:Psychometrics; D012074:Remission Induction; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007792:Lactulose
keywords: lactulose; minimal hepatic encephalopathy; spectral EEG