Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines

Jean Michel Guerit, Aldo Amantini, Catherine Fischer, Peter W Kaplan, Oriano Mecarelli, Alfons Schnitzler, Emilio Ubiali, Piero Amodio

Research output: Contribution to journalArticle

Abstract

By studying neuronal activity through neuronal electrogenesis, neurophysiological investigations provide a functional assessment of the nervous system and, therefore, has been used for quantitative assessment and follow-up of hepatic encephalopathy (HE). The different clinical neurophysiological approaches can be classified depending on the function to explore and their sensitivity to HE. The reliable techniques are those that reflect cortical function, i.e., cognitive-evoked potentials (EPs) (P300 paradigm), electroencephalogram (EEG), visual EPs (latency > 100 ms) and somatosensory EPs (SEPs) (latency between 25 and 100 ms). Short-latency EPs (brainstem acoustic EPs, SEPs of a latency <25 ms) are in principle insensitive to HE, but can disclose brainstem conduction deficits due to oedema. SEPs and motor EPs can disclose myelopathies. Because of its parallelism to the clinical examination, clinical neurophysiology can complement the neurological examination: (i) to provide evidence of HE in patients who have normal consciousness; (ii) to rule out, at least under some conditions, disturbances of consciousness due to other causes (e.g. drug-induced disturbances, non-convulsive status epilepticus) with the reservation that the mildest degrees of encephalopathy might be associated with an EEG pattern similar to that induced by drugs; and (iii) to demonstrate the worsening or, conversely improvement, of HE in the follow-up period.

Original languageEnglish (US)
Pages (from-to)789-796
Number of pages8
JournalLiver International
Volume29
Issue number6
DOIs
StatePublished - 2009

Fingerprint

Hepatic Encephalopathy
Practice Guidelines
Somatosensory Evoked Potentials
Consciousness
Evoked Potentials
Electroencephalography
Motor Evoked Potentials
Neurophysiology
Visual Evoked Potentials
Brain Stem Auditory Evoked Potentials
Status Epilepticus
Spinal Cord Diseases
Neurologic Examination
Brain Diseases
Pharmaceutical Preparations
Cognition
Nervous System
Brain Stem
Edema

Keywords

  • Acute liver failure
  • Cirrhosis
  • Electro-encephalogram
  • Encephalopathy
  • Evoked potentials
  • Neurophysiology

ASJC Scopus subject areas

  • Hepatology

Cite this

Guerit, J. M., Amantini, A., Fischer, C., Kaplan, P. W., Mecarelli, O., Schnitzler, A., ... Amodio, P. (2009). Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines. Liver International, 29(6), 789-796. https://doi.org/10.1111/j.1478-3231.2009.02030.x

Neurophysiological investigations of hepatic encephalopathy : ISHEN practice guidelines. / Guerit, Jean Michel; Amantini, Aldo; Fischer, Catherine; Kaplan, Peter W; Mecarelli, Oriano; Schnitzler, Alfons; Ubiali, Emilio; Amodio, Piero.

In: Liver International, Vol. 29, No. 6, 2009, p. 789-796.

Research output: Contribution to journalArticle

Guerit, JM, Amantini, A, Fischer, C, Kaplan, PW, Mecarelli, O, Schnitzler, A, Ubiali, E & Amodio, P 2009, 'Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines', Liver International, vol. 29, no. 6, pp. 789-796. https://doi.org/10.1111/j.1478-3231.2009.02030.x
Guerit, Jean Michel ; Amantini, Aldo ; Fischer, Catherine ; Kaplan, Peter W ; Mecarelli, Oriano ; Schnitzler, Alfons ; Ubiali, Emilio ; Amodio, Piero. / Neurophysiological investigations of hepatic encephalopathy : ISHEN practice guidelines. In: Liver International. 2009 ; Vol. 29, No. 6. pp. 789-796.
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