title: Minimal hepatic encephalopathy: A review.
abstract: Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of patients with liver cirrhosis. By definition, MHE is characterized by cognitive function impairment in the domains of attention, vigilance and integrative function, but obvious clinical manifestation are lacking. MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis can be achieved through neuropsychological testing, recently developed computerized psychometric tests, such as the critical flicker frequency and the inhibitory control tests, as well as neurophysiological procedures. Event related potentials can reveal subtle changes in patients with normal neuropsychological performances. Spectral analysis of electroencephalography (EEG) and quantitative analysis of sleep EEG provide early markers of cerebral dysfunction in cirrhotic patients with MHE. Neuroimaging, in particular MRI, also increasingly reveals diffuse abnormalities in intrinsic brain activity and altered organization of functional connectivity networks. Medical treatment for MHE to date has been focused on reducing serum ammonia levels and includes non-absorbable disaccharides, probiotics or rifaximin. Liver transplantation may not reverse the cognitive deficits associated with MHE. We performed here an updated review on epidemiology, burden and quality of life, neuropsychological testing, neuroimaging, neurophysiology and therapy in subjects with MHE.
authors.affiliation: Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Italy. Electronic address: raffaele.nardone@asbmeran-o.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Nardone
authors.affiliation: Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Taylor
authors.affiliation: Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Höller
authors.affiliation: Department of Neurology, Franz Tappeiner Hospital, Italy; Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Brigo
authors.affiliation: Department of Neurology, Saarland University Medical Center, Homburg, Germany.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Lochner
authors.affiliation: Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D004569:Electroencephalography; D005071:Evoked Potentials; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D059906:Neuroimaging; D009483:Neuropsychological Tests; D011788:Quality of Life
keywords: Electroencephalography; Event related potentials; Hepatic encephalopathy; Magnetic resonance imaging; Minimal hepatic encephalopathy; Neuropsychological testing