Abstract
Study design:
Experimental neurophysiological study.
Objectives:
The hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while there are only a few reports of sensory impairment. However, sensory function has been poorly explored in HM. We believe that an electrophysiological assessment of dorsal columns by somatosensory evoked potentials (SEPs) and of cortico-spinal lateral tracts by motor evoked potentials (MEPs) should be of considerable value in the functional evaluation of the spinal cord involvement in patients with HM.
Setting:
Salzburg (Austria) and Merano (Italy).
Methods:
Eight patients diagnosed with HM were studied with MEPs and SEPs. Neurological examination revealed different degrees of cortico-spinal tract involvement in all patients and sensory abnormalities in three patients.
Results:
Central motor conduction to lower limb muscles was abnormal in all patients, while central sensory conduction was abnormal in seven out of the eight patients. Both central motor and sensory conduction to upper limbs are normal in all patients.
Conclusion:
The main finding is that electrophysiological evidence of central sensory involvement is present in a very high percentage of patients with HM, and that the threshold for electrophysiological abnormalities is below that for clinical manifestations. Therefore, central sensory and motor conduction studies are sensitive methods for detecting, localizing and monitoring spinal cord damage in HM.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Zieve L, Mendelson DF, Goepfert M . Shunt encephalomyelopathy. II. Occurrence of permanent myelopathy. Ann Intern Med 1960; 53: 53–63.
Liversedge LA, Rawson MD . Myelopathy in hepatic disease and portosystemic venous anastamosis. Lancet 1966; 1: 277–279.
Bain VG, Bailey RJ, Jhamandas JH . Postshunt myelopathy. J Clin Gastroenterol 1991; 13: 562–564.
Leigh AD, Card WI . Hepato-lenticular degeneration. A case associated with posterior-lateral column degeneration. J Neuropathol Exp Neurol 1949; 8: 338.
Nardone R, Buratti T, Oliviero A, Lochmann A, Tezzon F . Corticospinal involvement in patients with a portosystemic shunt due to liver cirrhosis: a MEP study. J Neurol 2006; 253: 81–85.
Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ et al. Non invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application: Report of IFCN committee. Electroencephalogr Clin Neurophysiol 1994; 91: 79–92.
Mills KR . Magnetic Stimulation of the Human Nervous System. Oxford University Press: Oxford. 1999.
Tsuji S, Shibasaki H, Kato M, Kuroiwa Y, Shima F . Subcortical thalamic and cortical somatosensory evoked potentials to median nerve stimulation. Electroencephalogr Clin Neurophysiol 1984; 59: 465–476.
Jones SJ, Small DG . Spinal and sub-cortical potentials following stimulation of the posterior tibial nerve in man. Electroencephalogr Clin Neurophysiol 1978; 44: 299–306.
Kakigi R, Shibasaki H, Hashizume A, Kuroiwa Y . Short latency somatosensory evoked spinal and scalp-recorded potentials following posterior tibila nerve stimulation in man. Electroencephalogr Clin Neurophysiol 1982; 53: 602–611.
Mendoza G, Marti-Fabregas J, Kulisevsky J, Escartin A . Hepatic myelopathy: a rare complication of portacaval shunt. Eur Neurol 1994; 34: 209–212.
Pant SS, Rebeiz JJ, Richardson EP Jr. . Spastic paraparesis following portocaval shunts. Neurology 1968; 18: 135–141.
Campellone JV, Lacomis D, Giuliani MJ, Kroboth FJ . Hepatic myelopathy. Case report with review of the literature. Clin Neurol Neurosurg 1996; 98: 242–246.
Lewis M, Howdle PD . The neurology of liver failure. Q J Med 2003; 96: 623–633.
Caldwell C, Werdiger N, Jakab S, Schilsky M, Arvelakis A, Kulkarni S et al. Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature. Liver Transpl 2010; 16: 818–826.
Troisi R, Debruyne J, de Hemptinne B . Improvement of hepatic myelopathy after liver transplantation. N Engl J Med 1999; 340: 151.
Weissenborn K, Tietge UJ, Bokemeyer M, Mohammadi B, Bode U, Manns MP et al. Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology 2003; 124: 346–351.
Counsell C, Warlow C . Failure of presumed hepatic myelopathy to improve after liver transplantation. J Neurol Neurosurg Psychiatry 1996; 60: 590.
Demirci M, Tan E, Elibol B, Gedikoglu G, Saribas O . Spastic paraparesis associated with portal-systemic venous shunting due to congenital hepatic fibrosis. Neurology 1992; 42: 983–985.
Yengue P, Adler M, Bouhdid H, Mavroudakis N, Gelin M, Bourgeois N . Hepatic myelopathy after splenorenal shunting: report of one case and review of the literature. Acta Gastroenterol Belg 2001; 64: 231–233.
Utku U, Asil T, Balci K, Uzunca I, Celik Y . Hepatic myelopathy with spastic paraparesis. Clin Neurol Neurosurg 2005; 107: 514–516.
Koo JE, Lim YS, Myung SJ, Suh KS, Kim KM, Lee HC et al. Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt. Korean J Hepatol 2008; 14: 89–96.
Comi G, Leocani L, Medaglini S, Locatelli T, Martinelli V, Santuccio G et al. Evoked potentials in diagnosis and monitoring of multiple sclerosis. Electroencephalogr Clin Neurophysiol Suppl 1999; 49: 13–18.
Hess CW, Mills KR, Murray NM, Schriefer TN . Magnetic brain stimulation: central motor conduction studies in multiple sclerosis. Ann Neurol 1987; 22: 744–745.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Nardone, R., Orioli, A., Höller, Y. et al. Central motor and sensory conduction in patients with hepatic myelopathy. Spinal Cord 52, 439–443 (2014). https://doi.org/10.1038/sc.2014.61
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2014.61
