Motor dysfunction in patients with liver cirrhosis: impairment of handwriting

Abstract

Motor dysfunction is an important clinical finding in patients with liver cirrhosis and mild forms of hepatic encephalopathy. The mechanisms and clinical appearance of motor impairment in patients with liver cirrhosis are not completely understood. We studied fine motor control in forty four patients with advanced liver cirrhosis (excluding those with hepatic encephalopathy grade II) and 48 healthy controls using a kinematic analysis of standardized handwriting tests. We analysed parameters of velocity, the ability to coordinate and the level of automatisation of handwriting movements. Furthermore, we studied the association between impairment of handwriting and clinical neuro-psychiatric symptoms. As compared with control subjects, patients showed a statistically significant reduction of movement peak velocity in all handwriting tasks as well as a substantial increase of number of velocity inversions per stroke. Using a z-score based assessment we found impairment of handwriting in fourteen out of forty four patients (31.8 %). The deterioration of handwriting was associated with clinical symptoms of motor dysfunction, such as bradykinesia, adiadochokinesia, dysmetria of upper extremities and gait ataxia. This is the first study that quantitatively investigates impairment of handwriting in patients with liver cirrhosis. Our findings suggest the application of kinematic analysis of handwriting for diagnostics of motor dysfunction in patients with mild forms of hepatic encephalopathy.

Activation of Neuronal Nitric Oxide Synthase in Cerebellum of Chronic Hepatic Encephalopathy Rats is Associated with Up-regulation of NADPH-Producing Pathway

“…A mild-grade chronic type persistent HE is characterized by the impairment in motor functions [9,10] and, thus, indicates derangements of cerebellar functions [11,12]. Cerebellum is likely to produce high amount of reactive oxygen species (ROS) [13] and, therefore, speculated to be more susceptible for oxidative stress during neuropathology.…”

Motor impairment in liver cirrhosis without and with minimal hepatic encephalopathy

“…Hepatic encephalopathy (HE) is a complication occurring in patients suffering from liver cirrhosis (1, 2), which is characterized by a variety of neuropsychological, vigilance, and motor deficits (3–6). The current opinion is that in minimal HE (mHE) (3, 4, 6–8), previously known as subclinical HE , apparent motor symptoms are lacking, but detailed movement analyses have already revealed slight motor impairments in mHE patients in fine motor control (9, 10). However, extensive neuropsychometric testing has so far been the only way of credibly assessing mHE (11, 12).…”

Sleep disturbance and daytime sleepiness in patients with cirrhosis: a case control study

“…Sleep disturbance and excessive daytime somnolence are common in patients with cirrhosis [1,2,3,4]. In addition, a disturbance of sleep is recognized as one of the early signs of hepatic encephalopathy [5,6,7].…”