Top

The Egyptian Journal of Neurology, Psychiatry and Neurosurgery

Published in:

Open Access 01-12-2021 | Liver Cirrhosis | Research

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

Authors: Mostafa M. Elkholy, Ragaey A. Eid

Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Issue 1/2021

Abstract

Background

Peripheral neuropathy is an underestimated problem of compensated liver cirrhosis despite its negative effect on quality of life. The aim was to assess the role of meticulous electrophysiological screening (nerve conduction responses and quantitative motor unit potential analysis) of subclinical peripheral nerve dysfunction in patients with compensated cirrhosis and also to explore its relations with different characteristics of liver disease. Severity of cirrhosis was assessed by Child–Pugh and albumin-bilirubin (ALBI) scores.

Results

Prevalence of hepatic neuropathy (HN) was 82%. It involved sensory and motor fibers (66%), and its pathophysiology was axonal (53.7%) or mixed axonal and demyelinating (46.3). The most sensitive discriminating tests were ulnar sensory conduction velocity (area under curve (AUC) = 0.915) and peak latency (AUC = 0.887), peroneal motor conduction velocity (AUC = 0.885), ulnar distal motor latency (AUC = 0.842), and first dorsal interosseous number of phases (AUC = 0.736). HN showed significant correlation with the severity of liver disease assessed by both child (P = 0.029) and ALBI (P = 0.016) scores and also correlated with the low serum albumin level (P = 0.001).

Conclusions

Subclinical mild axonal polyneuropathy is very common in post-hepatitis C compensated cirrhosis picked up by meticulous electrophysiological testing, and it is related to severity of liver cirrhosis and low serum albumin level.

Available only for authorised users

GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245–66.CrossRef

Doss W, Hermez J, Atta H, Jabbour J. Towards a hepatitis-free Egypt: is this achievable? East Mediterr Health J. 2018;24(7):609–10. https://doi.org/10.26719/2018.24.7.609.CrossRefPubMed

Keresztes K, Istenes I, Folhoffer A, Lakatos PL, Horvath A, Csak T, et al. Autonomic and sensory nerve dysfunction in primary biliary cirrhosis. World J Gastroenterol. 2004;10(20):3039–43. https://doi.org/10.3748/wjg.v10.i20.3039.CrossRefPubMedPubMedCentral

Kharbanda PS, Prabhakar S, Chawla YK, Das CP, Syal P. Peripheral neuropathy in liver cirrhosis. J Gastroenterol Hepatol. 2003;18(8):922–6. https://doi.org/10.1046/j.1440-1746.2003.03023.x.CrossRefPubMed

Abdelkader NA, Zaky DZ, Afifi H, Saad WE, Shalaby SI, Mansour MA. Neuropathies in hepatitis C-related liver cirrhosis. Indian J Gastroenterol. 2014;33(6):554–9. https://doi.org/10.1007/s12664-014-0509-4.CrossRefPubMed

Jain J, Singh R, Banait S, Verma N, Waghmare S. Magnitude of peripheral neuropathy in cirrhosis of liver patients from central rural India. Annals Ind Academy Neurol. 2014;17(4):409–107. https://doi.org/10.4103/0972-2327.144012.CrossRef

Lai JC, Dodge JL, McCulloch CE, Covinsky KE, Singer JP. Frailty and the burden of concurrent and incident disability in patients with cirrhosis: a prospective cohort study. Hepatol Commun. 2020;4(1):126–33. https://doi.org/10.1002/hep4.1444.CrossRefPubMed

Albers I, Hartmann H, Bircher J, Creutzfeldt W. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis. Scand J Gastroenterol. 1989;24(3):269–76. https://doi.org/10.3109/00365528909093045.CrossRefPubMed

Sofka CM. Non-invasive evaluation of liver cirrhosis using ultrasound. Ultrasound Q. 2010;26(2):115.

10.

Fragaki M, Sifaki-Pistolla D, Orfanoudaki E, Kouroumalis E. Comparative evaluation of ALBI, MELD, and Child-Pugh scores in prognosis of cirrhosis: is ALBI the new alternative? Ann Gastroenterol. 2019;32(6):626–32. https://doi.org/10.20524/aog.2019.0417.CrossRefPubMedPubMedCentral

11.

Xiong Q, Lu B, Ye H, Wu X, Zhang T, Li Y. The diagnostic value of neuropathy symptom and change score, neuropathy impairment score and Michigan neuropathy screening instrument for diabetic peripheral neuropathy. Eur Neurol. 2015;74(5-6):323–7. https://doi.org/10.1159/000441449.CrossRefPubMed

12.

Preston DC, Shapiro BE. Electromyography and neuromuscular disorders e-book: clinical-electrophysiologic correlations (Expert Consult-Online): Elsevier Health Sciences; 2012.

13.

Sonoo M, Stålberg E. The ability of MUP parameters to discriminate between normal and neurogenic MUPs in concentric EMG: analysis of the MUP “thickness” and the proposal of “size index”. Electroencephalogr Clin Neurophysiol. 1993;89(5):291–303. https://doi.org/10.1016/0168-5597(93)90068-Z.CrossRefPubMed

14.

Mittal M, Singh PK, Kurrian S. Study of prevalence and pattern of peripheral neuropathy in patients with liver cirrhosis. Int J Adv Med. 2017;4(4):1041–5. https://doi.org/10.18203/2349-3933.ijam20173228.CrossRef

15.

Knill-Jones RP, Goodwill CJ, Dayan AD, Williams R. Peripheral neuropathy in chronic liver disease: clinical, electrodiagnostic, and nerve biopsy findings. J Neurol Neurosurg Psychiatry. 1972;35(1):22–30. https://doi.org/10.1136/jnnp.35.1.22.CrossRefPubMedPubMedCentral

16.

Chari VR, Katiyar BC, Rastogi BL, Bhattacharya SK. Neuropathy in hepatic disorders. A clinical, electrophysiological, and histopathological appraisal. J Neurol Sci. 1977;31(1):93–111. https://doi.org/10.1016/0022-510X(77)90008-9.CrossRefPubMed

17.

Santoro L, Manganelli F, Briani C, Giannini F, Benedetti L, Vitelli E, et al. Prevalence and characteristics of peripheral neuropathy in hepatitis C virus population. J Neurol Neurosurg Psychiatry. 2006;77(5):626–9. https://doi.org/10.1136/jnnp.2005.081570.CrossRefPubMedPubMedCentral

18.

Beghi E, Monticelli L, Italian General Practitioner Study Group. Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation of risk factors for polyneuropathy in two Italian communities. J Clin Epidemiol. 1998;51(8):697–702. https://doi.org/10.1016/S0895-4356(98)00039-0.CrossRefPubMed

19.

Bromberg MB. The motor unit and quantitative electromyography. Muscle Nerve. 2020;61(2):131–42. https://doi.org/10.1002/mus.26718.CrossRefPubMed

20.

Gilmore KJ, Morat T, Doherty TJ, Rice CL. Motor unit number estimation and neuromuscular fidelity in 3 stages of sarcopenia. Muscle Nerve. 2017;55(5):676–84. https://doi.org/10.1002/mus.25394.CrossRefPubMed

21.

McNeil CJ, Doherty TJ, Stashuk DW, Rice CL. Motor unit number estimates in the tibialis anterior muscle of young, old, and very old men. Muscle Nerve. 2005;31(4):461–7. https://doi.org/10.1002/mus.20276.CrossRefPubMed

22.

Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA. The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis. J Gen Intern Med. 2015;30(8):1193–203. https://doi.org/10.1007/s11606-015-3354-y.CrossRefPubMedPubMedCentral

23.

Cocito D, Maule S, Paolasso I. High prevalence of neuropathies in patients with end-stage liver disease. Acta Neurol Scand. 2010;122(1):36–40. https://doi.org/10.1111/j.1600-0404.2009.01256.x.CrossRefPubMed

24.

Chaudhry V, Corse AM, O’Brian R, Cornblath DR, Klein AS, Thuluvath PJ. Autonomic and peripheral (sensorimotor) neuropathy in chronic liver disease: a clinical and electrophysiologic study. Hepatology. 1999;29(6):1698–703. https://doi.org/10.1002/hep.510290630.CrossRefPubMed

25.

Hendrickse MT, Thuluvath PJ, Triger DR. Natural history of autonomic neuropathy in chronic liver disease. Lancet. 1992;339(8807):1462–4. https://doi.org/10.1016/0140-6736(92)92042-E.CrossRefPubMed

26.

Li L, Liu B, Lu J, Jiang L, Zhang Y, Shen Y, et al. Serum albumin is associated with peripheral nerve function in patients with type 2 diabetes. Endocrine. 2015;50(2):397–404. https://doi.org/10.1007/s12020-015-0588-8.CrossRefPubMed

27.

Iwasaki T, Togashi Y, Terauchi Y. Significant association of serum albumin with severity of retinopathy and neuropathy, in addition to that of nephropathy, in Japanese type 2 diabetic patients. Endocr J. 2008;55(2):311–6. https://doi.org/10.1507/endocrj.K07-086.CrossRefPubMed

28.

Chopra JS, Samanta AK, Murthy JM, Sawhney BB, Datta DV. Role of porta systemic shunt and hepatocellular damage in the genesis of hepatic neuropathy. Clin Neurol Neurosurg. 1980;82(1):37–44. https://doi.org/10.1016/0303-8467(80)90058-X.CrossRefPubMed

29.

Dayan AD, Williams R. Demyelinating peripheral neuropathy and liver disease. Lancet. 1967;2(7507):133–4. https://doi.org/10.1016/s0140-6736(67)92967-4.CrossRefPubMed

30.

Kardel T, Nielsen VK. Hepatic neuropathy: a clinical and electrophysiological study. Acta Neurol Scand. 1974;50(4):513–26.CrossRef

31.

Apartis E, Leger JM, Musset L, Gugenheim M, Cacoub P, Lyon-Caen O, et al. Peripheral neuropathy associated with essential mixed cryoglobulinemia: a role for hepatitis C virus infection? J Neurol Neurosurg. Psychiatry. 1996;60:661–6.

32.

David WS, Peine C, Schlesinger P, Smith SA. Nonsystemic vasculitic mononeuropathy multiplex, cryoglobulinemia, and hepatitis C. Muscle Nerve. 1996;19(12):1596–602. https://doi.org/10.1002/(SICI)1097-4598(199612)19:12<1596::AID-MUS9>3.0.CO;2-5.CrossRefPubMed

33.

Bonetti B, Invernizzi F, Rizzuto N, Bonazzi ML, Zanusso G, Chinaglia G, et al. T-cell-mediated epineurial vasculitis and humoral-mediated microangiopathy in cryoglobulinemic neuropathy. J Neuroimmunol. 1997;73(1-2):145–54. https://doi.org/10.1016/S0165-5728(96)00191-9.CrossRefPubMed

34.

Authier FJ, Bassez G, Payan C, Guillevin L, Pawlotsky JM, Degos JD, et al. Detection of genomic viral RNA in nerve and muscle of patients with HCV neuropathy. Neurology. 2003;60(5):808–12. https://doi.org/10.1212/01.WNL.0000044399.71601.EA.CrossRefPubMed

35.

Karl NG, Lin Cindy S-Y, Nicholas MF, Burroughs AK, Bostock H. Conduction and excitability properties of peripheral nerves in end-stage liver disease. Muscle Nerve. 2007;35:730–8.CrossRef

36.

Gentilini P, La Villa G, Casini-Raggi V, Romanelli RG. Hepatorenal syndrome and its treatment today. Eur J Gastroenterol Hepatol. 1999;11(9):1061–5. https://doi.org/10.1097/00042737-199909000-00021.CrossRefPubMed

37.

Menon KV, Kamath PS. Regional and systemic hemodynamic disturbances in cirrhosis. Clin Liver Dis. 2001;5(3):617–27. https://doi.org/10.1016/S1089-3261(05)70184-7.CrossRefPubMed

38.

Caraceni P, Domenicali M, Tovoli A, Napoli L, Ricci CS, Tufoni M, et al. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med. 2013;24(8):721–8. https://doi.org/10.1016/j.ejim.2013.05.015.CrossRefPubMed

39.

Navarro JF, Mora C. Role of inflammation in diabetic complications. Nephrol Dial Transplant. 2005;20(12):2601–4. https://doi.org/10.1093/ndt/gfi155.CrossRefPubMed

40.

Pazdro R, Burgess JR. The role of vitamin E and oxidative stress in diabetes complications. Mech Ageing Dev. 2010;131(4):276–86. https://doi.org/10.1016/j.mad.2010.03.005.CrossRefPubMed

41.

Sandireddy R, Yerra VG, Areti A, Komirishetty P, Kumar A. Neuroinflammation and oxidative stress in diabetic neuropathy: futuristic strategies based on these targets. Int J Endocrinol. 2014;2014:1–10. https://doi.org/10.1155/2014/674987.CrossRef

Title: Quantitative motor unit potential analysis and nerve conduction studies for detection of subclinical peripheral nerve dysfunction in patients with compensated liver cirrhosis
Authors: Mostafa M. Elkholy
Ragaey A. Eid
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Liver Cirrhosis
Hepatitis C
Published in: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery / Issue 1/2021
Electronic ISSN: 1687-8329
DOI: https://doi.org/10.1186/s41983-021-00348-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Correlation of cortical lesions of multiple sclerosis at double inversion recovery with cognition screening scores

Interictal autonomic dysfunction in patients with epilepsy

Pattern and prevalence of neuropsychiatric lupus: a retrospective study from a tertiary level hospital in Bangladesh

Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke

Evaluation of risk factors for cerebral palsy

Clinical features contributing to the sit-to-stand transfer in people with Parkinson’s disease: a systematic review