Critical Flicker Frequency is Diagnostic of Minimal Hepatic Encephalopathy

IntroductionDiagnosis of Minimal hepatic encephalopathy (MHE) requires psychometric tests, although new methods are needed since sensitivity, specificity, and accuracy are low.The P300 event-related potential (ERP) is obtained by auditory and visual stimuli, although only the auditory P300 has been used to detect MHE. We aimed to compare the diagnostic features of auditory and visual P300 to detect MHE. Materials and methods Sixty patients with liver cirrhosis and thirty-five healthy controls completed thePsychometric Hepatic Encephalopathy Score (PHES), the critical flicker frequency (CFF), auditory, and visual P300. MHE was diagnosed if PHES and CFF scores were abnormal. ResultsFifty-three cirrhotic patients (age 54.5±8.6 years) completed all tests. Abnormal scores were: PHES (49.1 %), CFF (67.9 %). The proportion of MHE was 21.4 %. The area under the receiver operating ROC curves (AUROC) for auditory P300 was better than visual P300 for distinguishing MHE from controls (AUROC 0.792 vs 0.725; p<0.005 for both; accuracy 73.8 %vs 70.2 %; sensitivity 72.2 % both; specificity 74.2 vs 69.7, respectively. Among cirrhotic patients, only auditory P300 was useful to detect MHE, AUROC 0.723 p<0.05; 77.4 % accuracy; 61.1 % sensitivity; and 81.8 % specificity. ConclusionsThe auditory P300 sensitivity, specificity, and accuracy were similar to those of CFF.Our results showed that only auditory P300 is useful to differentiate patients with MHE. Although both modalities, auditory and visual, differentiated patients with cirrhosis from controls, we consider the visual P300 is not suitable for detecting MHE.

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“…This method has been used to assess the CFF's accuracy in diagnosing MHE in patients with post-hepatitis C liver cirrhosis (25).…”

Section: Discussionmentioning

confidence: 99%

Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy

Vargas

Tijera

Hernández³

2021

Rev Esp Enferm Dig

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“…Critical flicker frequency (CFF) is a neurophysiological technique that measures the capability to detect flickering light directly influenced by cortical activity in the central nervous system [ 21 , 24 ]. We used a Hepatonorm Analyzer (nevoLAB GmbH, Maierhöfen, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…Two tools have been validated for diagnosing mHE: the Psychometric Hepatic Encephalopathy Score (PHES) [15,16] the Critical flicker frequency (CFF) [17][18][19]. These neurophysiological tests are simple, rapid, effective, and reliable, with high specificity and reproducibility and can predict the risk for mortality and developing overt encephalopathy [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cerebral dysfunction in patients with chronic kidney disease using neuropsychometric and neurophysiological tests

et al. 2021

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Background: Uremic encephalopathy is defined as cerebral dysfunction due to toxin accumulation in patients with chronic kidney disease (CKD). This condition is characterized by subtle to florid symptoms, and its clinical course is always progressive when untreated but partially reversible with renal replacement therapy. While no test exists to measure subclinical uremic encephalopathy, two tests have been validated to measure minimal hepatic encephalopathy: the critical flicker frequency (CFF) test and the psychometric hepatic encephalopathy score (PHES). Objective: To use CFF and PHES to measure the prevalence of cerebral dysfunction in individuals with CKD. Methods: This cross-sectional study included a total of 69 patients with stage-5 CKD. Cutoff points for minimal encephalopathy were established using existing clinical guidelines: 39 Hz for CFF and < À4 for PHES. All participants were also screened for cognitive function and depression. Results: Eighteen cases (26.1%) of cerebral dysfunction linked to uremic encephalopathy were detected with CFF, while twelve (17.4%) were detected by PHES; only six cases (8.7%) were diagnosed by both methods. Half of the cases (50%) had diabetes, and 61% were on hemodialysis. Cognitive function scores did not differ significantly between those receiving dialysis, hemodialysis, or no renal replacement therapy. Conclusions: It is essential to identify cerebral dysfunction when uremic encephalopathy is in early subclinical stages to reduce preventable events as traffic and work accidents.

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“…As regard central nervous system affection, there were seventeen publications, most of them studied hepatic encephalopathy from early detection, diagnosis, management and prognosis (288)(289)(290)(291)(292)(293), one article studied minimal hepatic encephalopathy in children (294). Also, sudomotor changes, extrapyramidal manifestations and depression were studied (295)(296)(297).…”

Section: Liver Cirrhosis and Its Complicationsmentioning

confidence: 99%

Liver diseases among Arab world, current state and unmet needs, a scoping review

Almansoury,

Abdel-Gawad,

Abdelghani

et al. 2023

Global Gastroenterology

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Critical Flicker Frequency is Diagnostic of Minimal Hepatic Encephalopathy

Cited by 4 publications

References 25 publications

Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy

Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy

Evaluation of cerebral dysfunction in patients with chronic kidney disease using neuropsychometric and neurophysiological tests

Liver diseases among Arab world, current state and unmet needs, a scoping review

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