Study of prevalence and pattern of peripheral neuropathy in patients with liver cirrhosis

Abstract

Background: Peripheral neuropathy is not an uncommon complication of liver cirrhosis but it is not given much clinical relevance. The pattern and prevalence of peripheral neuropathy has also not been studied extensively. Alcohol use, coexisting diseases and nutritional deficiency have been postulated as factors responsible for neuropathy. The aim of this study was to define the pattern and prevalence of neuropathy in cirrhosis and to determine any etiologic correlation.Methods: 85 patients of cirrhosis of liver were studied. Apart from routine investigations, serum vitamin B12 estimation was also done in these patients. Electrophysiological studies were done in 46 patients.Results: Alcohol was the most common etiology of cirrhosis (57.6%). Hepatitis B related (11.8%) and Hepatitis C (4.7%) were other etiologies. The prevalence of peripheral neuropathy by electrophysiological studies was found to be 67.39% in cirrhosis of any etiology, of which 43.5% had sensorimotor type and the predominant pattern of peripheral neuropathy was mixed axonal degeneration and demyelination. The peripheral neuropathy was significantly more (p=0.01) in child class C than other child classes. Prevalence of neuropathy had no significant difference (p=1.00) between alcoholic and non-alcoholic cirrhosis. No correlation was present with either serum vitamin B12 levels or blood glucose levels.Conclusions: Peripheral neuropathy is present in more than half of cirrhosis patients and is unrelated to etiology and nutritional status but related to the severity of cirrhosis.

Quantitative motor unit potential analysis and nerve conduction studies for detection of subclinical peripheral nerve dysfunction in patients with compensated liver cirrhosis

“…Most previous studies showed a mixed pattern of peripheral nerve involvement (axonal and demyelinating, sensorimotor affection) in agreement with our findings [4,6,14]; however, other studies showed histopathologic evidence of segmental demyelination and remyelination in sural nerves of patients with hepatic neuropathy [15,16].…”

“…If we moved to the relation between severity of liver cirrhosis and HN, previous studies showed contradictory results. While our finding of a positive interrelation accords with some studies [14,23,24], others showed no significant correlation [4][5][6].…”

Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation

“…The prevalence of peripheral neuropathy was 72.3% and was affected mainly by the duration and severity of liver cirrhosis that was determined by Child‐Pugh classification 7 . Close percentages were also found: 67.39%, 5 and 73%, 8 of cirrhotic patients despite different aetiologies of liver cirrhosis.…”

“…Nervous dysfunction could be due to the association with abnormality of glucose metabolism and hence higher prevalence of diabetes mellitus among cirrhotic patients that may reach about 20–60% of patients 5 . Also, the evidence introduced by the nerve excitability studies in the cirrhotic patients suggests depolarization probably caused by ischaemia resulting from imbalance of potent vasoconstrictors (such as endothelin) and vasodilators (such as nitric oxide) resulting in poor nerve perfusion 4 …”

“…The associated peripheral neuropathy could impact the patient's condition and prognosis 5 . Autonomic neuropathy, in patients with chronic liver disease, is accompanied by failure of the compensatory mechanisms in the overwhelming stress, which may explain the apparent increase in mortality in those patients 9 …”