Electroencephalography Versus Psychometric Tests in Diagnosis of Minimal Hepatic Encephalopathy

Abstract

Background: Minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis is defined by the presence of otherwise unexplained cognitive abnormalities, only detectable on psychometric or neurophysiological testing, in the absence of overt hepatic encephalopathy (OHE). The objectives were to study the incidence of MHE in patients with liver cirrhosis, and to compare the sensitivity of the electroencephalography (EEG) versus psychometric hepatic encephalopathy score (PHES) in its diagnosis.

Methods: This study was conducted on 50 patients with liver cirrhosis. All patients underwent complete medical and neurological examination, laboratory investigations, abdominal ultrasound, EEG, and PHES involving star construction test, the number connection tests, block design test, the digit symbol test, the line drawing test and the circle dotting test.

Results: The neuropsychiatric symptoms (but not sufficient to diagnose OHE) were present in 40% of our patients. The psychometric test results were positive in 80% of them. EEG records showed that 64.7% of the patients had no slow waves, 23.5% showed theta waves, 9.8% showed delta waves, while no patients showed triphasic waves. There was a significant correlation between slow waves in EEG and inattention, amnesia and disturbed thinking (P < 0.05). Also, it was present between psychometric test results and inattention, amnesia, and sleep disturbances (P < 0.05). There was a very significant correlation between psychometric test and Child score (P < 0.05), while it was not present between Child score and slow waves in EEG records (P > 0.05).

Conclusion: The PHES and EEG are important in diagnosis of MHE in patients with liver cirrhosis, but PHES appears to be more sensitive than EEG.




J Neurol Res. 2016;6(4):65-71
doi: http://dx.doi.org/10.14740/jnr391w