Recovery from Parkinson Syndrome and Prolonged Visually Evoked Potentials in Hepatic Encephalopathy

Overview

Journal Metab Brain Dis

Publisher Springer

Specialties Endocrinology
Neurology

Date 2005 May 28

PMID 15918550

Authors

Josef Finsterer

Elisabeth Bernauer

Affiliations

Soon will be listed here.

Abstract

The combination of Parkinson syndrome (PS) and prolonged visually evoked potentials (VEPs) in a single patient with hepatic encephalopathy (HE) has not been reported. A 52-year-old male with chronic HE developed PS in early 2001. Treatment with L-DOPA was only of minimal effect. In August 2001 he was admitted because of worsening PS and HE. There was anemia, hyperlipidaemia, markedly elevated liver-function-parameters, hyperammonemia, elevated resting-lactate, steatosis hepatis and hepatomegalia. VEPs showed markedly prolonged P100-latencies. Under L-DOPA, pramipexol, L-ornithin-L-aspartate, paromomycin-sulfate, and lactulose liver-function-parameters normalized and PS markedly improved. In February 2003, VEPs were normal. L-DOPA was discontinued by the patient in April 2003 and pramipexol in December 2003. Since then PS did not recur. This case shows that HE may go along with reversible PS and prolonged VEPs. Under adequate therapy liver-function-parameters and VEPs normalize and PS disappears.

References

Watanabe A . Cerebral changes in hepatic encephalopathy. J Gastroenterol Hepatol. 1998; 13(7):752-60. DOI: 10.1111/j.1440-1746.1998.tb00728.x. View

Davies M, Rowan M, Feely J . EEG and event related potentials in hepatic encephalopathy. Metab Brain Dis. 1991; 6(4):175-86. DOI: 10.1007/BF00996917. View

Blei A . Diagnosis and treatment of hepatic encephalopathy. Baillieres Best Pract Res Clin Gastroenterol. 2001; 14(6):959-74. DOI: 10.1053/bega.2000.0141. View

Watanabe M, Ozaki T, Mushiroi T, Ukai Y, Ueda F, Kimura K . Behavioral and electroencephalographic studies of beagles with an Eck's fistula: suitability as a model of hepatic encephalopathy. Pharmacol Biochem Behav. 1997; 57(1-2):367-75. DOI: 10.1016/s0091-3057(96)00305-x. View

Haussinger D, Kircheis G . [Hepatic encephalopathy]. Praxis (Bern 1994). 2002; 91(22):957-63. DOI: 10.1024/0369-8394.91.22.957. View

Dasarathy S, Mullen K . Hepatic Encephalopathy. Curr Treat Options Gastroenterol. 2001; 4(6):517-526. DOI: 10.1007/s11938-001-0017-3. View

Watanabe M, Ozaki T, Mushiroi T, Ukai Y, Ueda F, Kimura K . [Ameliorating effect of lactitol on experimental hepatic encephalopathy in Eck fistula dogs]. Nihon Yakurigaku Zasshi. 1995; 105(5):403-13. DOI: 10.1254/fpj.105.403. View

VLAHCEVIC Z . Hepatic encephalopathy. Metabolic consequence of cirrhosis often is reversible. Postgrad Med. 2001; 109(2):52-4, 57-60, 63-5 passim. DOI: 10.3810/pgm.2001.02.850. View

Canbakan B, Canbakan M, Oz V, Tuncer M, Demir M . [Blindness as a complication of hepatic encephalopathy]. Wien Med Wochenschr. 2002; 151(18-20):477-80. View

10.

Gerber T, Schomerus H . Hepatic encephalopathy in liver cirrhosis: pathogenesis, diagnosis and management. Drugs. 2001; 60(6):1353-70. DOI: 10.2165/00003495-200060060-00008. View

11.

Higuchi K, Shimizu Y, Nambu S, Miyabayashi C, Takahara T, Saito S . Effects of an infusion of branched-chain amino acids on neurophysiological and psychometric testings in cirrhotic patients with mild hepatic encephalopathy. J Gastroenterol Hepatol. 1994; 9(4):366-72. DOI: 10.1111/j.1440-1746.1994.tb01257.x. View

12.

Kohira I, Matsuo E, Shiro Y, Uemura N, Matsumoto S, Kitamura Y . Hepatic encephalopathy with increased cerebral blood flow in SPECT and MRI abnormalities in the basal ganglia. Jpn J Psychiatry Neurol. 1994; 48(1):33-6. DOI: 10.1111/j.1440-1819.1994.tb02993.x. View

13.

Butterworth R . Pathophysiology of hepatic encephalopathy: a new look at ammonia. Metab Brain Dis. 2003; 17(4):221-7. DOI: 10.1023/a:1021989230535. View

14.

Butterworth R . Hepatic encephalopathy: a neuropsychiatric disorder involving multiple neurotransmitter systems. Curr Opin Neurol. 2001; 13(6):721-7. DOI: 10.1097/00019052-200012000-00018. View

15.

Joebges E, Heidemann M, Schimke N, Hecker H, Ennen J, Weissenborn K . Bradykinesia in minimal hepatic encephalopathy is due to disturbances in movement initiation. J Hepatol. 2003; 38(3):273-80. DOI: 10.1016/s0168-8278(02)00423-3. View

16.

Corbalan R, Hernandez-Viadel M, Llansola M, Montoliu C, Felipo V . Chronic hyperammonemia alters protein phosphorylation and glutamate receptor-associated signal transduction in brain. Neurochem Int. 2002; 41(2-3):103-8. DOI: 10.1016/s0197-0186(02)00030-x. View

17.

Burkhard P, Delavelle J, Du Pasquier R, Spahr L . Chronic parkinsonism associated with cirrhosis: a distinct subset of acquired hepatocerebral degeneration. Arch Neurol. 2003; 60(4):521-8. DOI: 10.1001/archneur.60.4.521. View

18.

Rama Rao K, Jayakumar A, Norenberg D . Ammonia neurotoxicity: role of the mitochondrial permeability transition. Metab Brain Dis. 2003; 18(2):113-27. DOI: 10.1023/a:1023858902184. View

19.

Raghavendra Rao V . Nitric oxide in hepatic encephalopathy and hyperammonemia. Neurochem Int. 2002; 41(2-3):161-70. DOI: 10.1016/s0197-0186(02)00038-4. View

20.

Jones E . Pathogenesis of hepatic encephalopathy. Clin Liver Dis. 2001; 4(2):467-85. DOI: 10.1016/s1089-3261(05)70119-7. View