Minimal hepatic encephalopathy is associated to alterations in eye movements

Abstract

Minimal hepatic encephalopathy (MHE) is diagnosed using PHES battery, but other tests are more sensitive, and a simple tool for early MHE detection is required. Assessment of saccadic eye movements is useful for early detection of cognitive alterations in different pathologies. We characterized the alterations in saccadic eye movements in MHE patients, its relationship with cognitive alterations and its utility for MHE diagnosis. One-hundred and eighteen cirrhotic patients (86 without and 32 with MHE) and 35 controls performed PHES and Stroop test and an eye movements test battery by OSCANN system: visual saccades, antisaccades, memory-guided saccades, fixation test and smooth pursuit. We analyzed 177 parameters of eye movements, assessed their diagnostic capacity for MHE, and correlated with cognitive alterations. MHE patients showed alterations in 56 of the 177 variables of eye movements compared to NMHE patients. MHE patients showed longer latencies and worse performance in most eye movements tests, which correlated with mental processing speed and attention impairments. The best correlations found were for antisaccades and memory-guided saccades, and some parameters in these tests could be useful for discriminating MHE and NMHE patients. Eye movements analysis could be a new, rapid, reliable, objective, and reproducible tool for early diagnose MHE.

Insights into the liver-eyes connections, from epidemiological, mechanical studies to clinical translation

“…It is worth noting that palsies of the 3rd, 4th, and 6th cranial nerve are rather common in neuro-ophthalmology practice, and GGT is one of the most sensitive indicators for liver function changes [ 6 ]. Moreover, it has been found that hepatic cirrhosis patients are prone to smooth pursuit eye movements (SPEM) disruption [ 35 ].…”

“…In recent years, the video electro-oculography (VOG) technique designed for early detection of dysfunctional cognitive/motor abilities in Parkinson’s, Alzheimer’s disease or multiple sclerosis has also been tested in diagnosing minimal hepatic encephalopathy (MHE), the earliest form of hepatic encephalopathy commonly found in liver cirrhosis patients [ 35 , 171 – 173 ]. The results showed that MHE patients have longer latencies and worse performance in most eye movement tests, of which the latency of reflexive saccades in vertical antisaccades test and the vertical version of the memory-guided saccades test [ 35 ]. The underlying mechanism relates to impaired mental processing speed and attention [ 35 ].…”

“…The results showed that MHE patients have longer latencies and worse performance in most eye movement tests, of which the latency of reflexive saccades in vertical antisaccades test and the vertical version of the memory-guided saccades test [ 35 ]. The underlying mechanism relates to impaired mental processing speed and attention [ 35 ]. In addition, artificial intelligence (AI)-based deep-learning (DL) algorithm has evolved rapidly in medical imaging-processing by automatically analyzing input graphs and coming to diagnosis data [ 174 , 175 ].…”