Spectral electroencephalogram analysis in hepatic encephalopathy and liver transplantation

Abstract

The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis (,EEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. ,EEG was compared with visual EEG (,EEG) in 44 cirrhotic patients waiting for OLT and 44 healthy controls. Eighteen patients had overt HE, and 26 patients had no apparent HE. Twenty-one transplant recipients were reexamined 6 months after OLT. Computerized ,EEG was performed by mean dominant frequency (MDF) and the occipital alpha-theta ratio, expressed as its logarithmic transformation (LogR). All

Incomplete improvement of visuo-motor deficits in patients with minimal hepatic encephalopathy after liver transplantation

“…Recent studies on the effects of LT on minimal hepatic encephalopathy have shown substantial improvement of neuropsychological parameters,12, 22, 33, 34 reduction of the encephalopathy‐associated changes of EEG10, 35, and improvement of cirrhosis‐associated brain metabolic alterations detected with the proton magnetic resonance spectroscopy 12, 20. On the other hand, several previous reports have shown incomplete reversibility of the crucial cirrhosis‐associated deficits 18, 24…”

Clinical Neurophysiology of Hepatic Encephalopathy

“…Eye opening reactivity can be reduced analysis of the digitalized EEG provides grading based on the exact quantification of the EEG components. 7,10,14,15,[22][23][24][25] Based on the relative power of frequency bands and MDF over approximately 60 s of EEG over posterior derivations, a classification was obtained that has prognostic value both in terms of survival and risk of development of overt HE 14 ( Table 2). The value of such approach was recently confirmed 26 and a large, validated observational study proved that the use of the MDF of the EEG improves the predictive value of the MELD score.…”

Is minimal hepatic encephalopathy completely reversible following liver transplantation?

“…They found that not all of the deficits observed were relative to the Crohn's control group and that these impairments were not attributable to encephalopathy alone but also may reflect the effects of complications of having a chronic illness. Furthermore, no spectral EEG alteration was observed in two controls to whom cyclosporine was administered following long‐term treatment of severe psoriasis 13. In addition, in the study by O'Carroll et al,9 the type of immunosuppression (cyclosporine vs. tacrolimus) did not have differential effects on quality of life, fatigue, or affective status, although those given cyclosporine showed greater improvements at 1‐year follow‐up on simple and choice reaction times.…”

“…This is supported by the study of O'Carroll et al,9 in which the Child‐Pugh rating at pre‐LT assessment was not predictive of psychological outcome after 1 year. However, more severe liver disease at pre‐LT assessment was associated with greater slowing of reaction times and an increased bioelectric brain dysfunction 13. In addition, regardless of the severity of underlying the liver disease, HE independently has detrimental effects on quality of life 19…”

“…after LT. In addition, others have demonstrated neurophysiological improvement in MHE after LT with brain metabolic alterations detected by means of proton magnetic resonance spectroscopy,3, 6, 11 positron emission tomography,12 and electroencephalography (EEG)13…”