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Tarek Hassanein - One of the best experts on this subject based on the ideXlab platform.
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performance of the Hepatic Encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe Hepatic Encephalopathy
The American Journal of Gastroenterology, 2009Co-Authors: Tarek Hassanein, Jan Stange, Fin Stolze Larsen, Brendan M Mcguire, Stephen H Caldwell, Robert S. Brown, William Perry, Robin C. Hilsabeck, Andres T Blei, Frederik NevensAbstract:Performance of the Hepatic Encephalopathy Scoring Algorithm in a Clinical Trial of Patients With Cirrhosis and Severe Hepatic Encephalopathy
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introduction to the Hepatic Encephalopathy scoring algorithm hesa
Digestive Diseases and Sciences, 2008Co-Authors: Tarek Hassanein, Robin C. Hilsabeck, William PerryAbstract:A primary obstacle to early diagnosis and treatment of Hepatic Encephalopathy (HE) is the lack of a well-validated, standardized assessment method. The purpose of this study was to present preliminary validity data on a new method of grading HE, the Hepatic Encephalopathy Scoring Algorithm (HESA), which combines clinical impressions with neuropsychological performances to characterize HE. Participants were 49 inpatients admitted for complications of end stage liver disease. Each participant’s level of HE was graded using HESA and the West Haven Criteria (WHC) by independent raters blinded to each other’s rating. A moderately strong association was found between the two grading methods (r = 0.60), and individual HESA clinical and neuropsychological indicators were good discriminators among grades. The results also suggest HESA may be more sensitive to mental status impairment in the middle grades of HE than WHC. These findings suggest HESA holds promise as a multi-method approach to grading all levels of HE.
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coil embolization of large spontaneous splenorenal shunt for chronic refractory Hepatic Encephalopathy
The American Journal of Gastroenterology, 2003Co-Authors: Todd Frederick, Ayad K M Agha, Steven C Rose, Tarek HassaneinAbstract:Coil embolization of large spontaneous splenorenal shunt for chronic refractory Hepatic Encephalopathy
Andres T Blei - One of the best experts on this subject based on the ideXlab platform.
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performance of the Hepatic Encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe Hepatic Encephalopathy
The American Journal of Gastroenterology, 2009Co-Authors: Tarek Hassanein, Jan Stange, Fin Stolze Larsen, Brendan M Mcguire, Stephen H Caldwell, Robert S. Brown, William Perry, Robin C. Hilsabeck, Andres T Blei, Frederik NevensAbstract:Performance of the Hepatic Encephalopathy Scoring Algorithm in a Clinical Trial of Patients With Cirrhosis and Severe Hepatic Encephalopathy
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albumin dialysis for the treatment of Hepatic Encephalopathy
Journal of Gastroenterology and Hepatology, 2004Co-Authors: Andres T BleiAbstract:Treatment of Hepatic Encephalopathy is hampered by the scant therapeutic options available to the practicing physician. Albumin dialysis has been proposed to improve the management of such patients, by removing both water-soluble and protein bound toxins. A recently completed trial of albumin dialysis in patients with severe Hepatic Encephalopathy offers the opportunity to evaluate the role of such a therapy. Such patients had Encephalopathy associated with acute-on-chronic liver failure rather than the result of precipitant-induced changes in mental state. In this entity, improvement in Encephalopathy may also require correction of the hemodynamic changes associated with liver failure.
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infection and the progression of Hepatic Encephalopathy in acute liver failure
Gastroenterology, 2003Co-Authors: Javier Vaquero, Julie Polson, Chuhan Chung, Irene Helenowski, Frank V Schiodt, Joan S Reisch, William M Lee, Andres T BleiAbstract:Abstract Background & Aims: Progression of Hepatic Encephalopathy (HE) is a major determinant of outcome in acute liver failure (ALF). Our aim was to identify predictive factors of worsening HE, including the relation of Encephalopathy with the systemic inflammatory response (SIRS) and infection. Methods: We included 227 consecutive patients with stage I-II HE prospectively enrolled in the U.S. Acute Liver Failure Study. Univariate and multivariate analysis of 27 variables at admission were performed separately for acetaminophen (n = 96) and nonacetaminophen (n = 131) etiologies. Results: On multivariate analysis, acquisition of infection during stage I-II HE ( P P P P P P Conclusions: This prospective evaluation points to infection and/or the resulting systemic inflammatory response as important factors contributing to worsening HE in ALF, mainly in patients with acetaminophen- induced ALF. The use of prophylactic antibiotics in these patients and the mechanisms by which infection triggers Hepatic Encephalopathy require further investigation.
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Hepatic Encephalopathy definition nomenclature diagnosis and quantification final report of the working party at the 11th world congresses of gastroenterology vienna 1998
Hepatology, 2002Co-Authors: Peter Ferenci, Kevin D Mullen, Karin Weissenborn, Alan H Lockwood, Ralph E Tarter, Andres T BleiAbstract:Research on Hepatic Encephalopathy is hampered by the imprecise definition of this disabling complication of liver disease. Under this light, the Organisation Mondiale de Gastroenterologie commissioned a Working Party to reach a consensus in this area and to present it at the 11th World Congress of Gastroenterology in Vienna (1998). The Working Party continued its work thereafter and now present their final report. In summary, the Working Party has suggested a modification of current nomenclature for clinical diagnosis of Hepatic Encephalopathy; proposed guidelines for the performance of future clinical trials in Hepatic Encephalopathy; and felt the need for a large study to redefine neuropsychiatric abnormalities in liver disease, which would allow the diagnosis of minimal (subclinical) Encephalopathy to be made on firm statistical grounds. In the interim, it proposes the use of a psychometric Hepatic Encephalopathy score, based on the result of 5 neuropsychologic tests. Finally, the need for a careful evaluation of the newer neuroimaging modalities for the diagnosis of Hepatic Encephalopathy was stressed.
Dieter Haussinger - One of the best experts on this subject based on the ideXlab platform.
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cortical activation associated with asterixis in manifest Hepatic Encephalopathy
Acta Neurologica Scandinavica, 2014Co-Authors: Dieter Haussinger, Markus Butz, Bettina Pollok, Martin Sudmeyer, Gerald Kircheis, Lars Timmermann, Joachim Gross, Alfons SchnitzlerAbstract:Objectives: Severe Hepatic Encephalopathy gives rise to asterixis, a striking motor symptom also called flapping tremor, which is characterized by a sudden ceasing of muscle tone in all muscles of a limb. In this study, we aimed at scrutinizing the cortical activation associated with asterixis and unraveling the underlying pathophysiological mechanisms. Material and methods: We recorded simultaneously neural activity with magnetoencephalography (MEG) and muscle activity with surface EMG in nine patients with manifest Hepatic Encephalopathy showing asterixis. Asterixis events were detected semiautomatically and served as triggers for averaging MEG signals. Evoked responses averaged time-locked to asterixis events were subjected to equivalent current dipole (ECD) modeling. Additionally, we localized the strongest cortico-muscular coherence in the frequency of the co-occurring tremulousness. Results: Evoked fields averaged time-locked to asterixis events were best explained by a single dipolar source in the contralateral primary motor cortex (M1, Talairach coordinates of mean localization: −40, −20, and 64; Brodmann area 4). This dipole showed a twofold field reversal, that is biphasic wave, with frontal dipole orientation at 49 ms before flap onset and 99 ms after flap onset. Conversely, two maxima with occipital dipole orientation were observed 2 ms and 160 ms after flap onset. Cortico-muscular coherence for the tremulousness was likewise localized in the contralateral M1 confirming earlier findings in the present patient cohort. Conclusions: Our results reveal an involvement of M1 in the generation of asterixis. As also tremulousness, also called mini-asterixis, was shown to originate in M1, asterixis and mini-asterixis may share common pathophysiological mechanisms.
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value of critical flicker frequency and psychometric Hepatic Encephalopathy score in diagnosis of low grade Hepatic Encephalopathy
Gastroenterology, 2014Co-Authors: Gerald Kircheis, Norbert Hilger, Dieter HaussingerAbstract:Background & Aims Critical flicker frequency (CFF) and psychometric Hepatic Encephalopathy score (PHES) analyses are widely used to diagnose Hepatic Encephalopathy (HE), but little is known about their value in the diagnosis of low-grade HE. Methods The diagnostic values of CFF and PHES were compared using a computerized test battery and West Haven criteria as reference. We performed CFF analysis on 559 patients with cirrhosis and 261 without (controls). Of these 820 patients, 448 were evaluated using a modified PHES system and 148 were also evaluated using the conventional PHES system. Results CFF distinguished between patients with overt HE and without minimal or overt HE in the entire study population with 98% sensitivity and 94% specificity and in the subgroup of patients who were evaluated by conventional PHES with 97% sensitivity and 100% specificity. Conventional PHES identified patients with overt HE with 73% sensitivity and 89% specificity. CFF distinguished between patients with and without minimal HE with only 37% sensitivity but 94% specificity (entire study population). In the subgroup of patients evaluated by conventional PHES, CFF distinguished between patients with and without minimal HE with 22% sensitivity and 100% specificity; these values were similar to those for conventional PHES (30% sensitivity and 89% specificity). The modified PHES distinguished between patients with and without minimal HE with 49% sensitivity and 74% specificity. The diagnostic agreement values between CFF and conventional or modified PHES in patients with minimal HE were only 54% or 47%, respectively. Conclusions In an analysis of patients with cirrhosis and controls, CFF distinguished between patients with overt HE and without minimal or overt HE. PHES testing produced a statistically significant difference among groups, but there was considerable overlap between controls and patients with overt HE. PHES, CFF, and a combination of PHES and CFF could not reliably distinguish patients with minimal HE from controls or those with overt HE.
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neurotransmitter receptor imbalances in motor cortex and basal ganglia in Hepatic Encephalopathy
Cellular Physiology and Biochemistry, 2009Co-Authors: Nicola Palomerogallagher, George Kostopoulos, Markus Cremer, Hans-jürgen Bidmon, Dieter Haussinger, Axel Schleicher, Guido Reifenberger, Gerald Kircheis, Karl ZillesAbstract:Hepatic Encephalopathy (HE) in chronic liver disease is characterized by neuropsychiatric and motor disturbances and associated with a net increase of inhibitory neurotransmission. Though many studies
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clinical efficacy of l ornithine l aspartate in the management of Hepatic Encephalopathy
Metabolic Brain Disease, 2002Co-Authors: Gerald Kircheis, Matthias Wettstein, Vom S Dahl, Dieter HaussingerAbstract:The clinical efficacy of both oral and parenteral L-ornithine-L-aspartate (OA) was confirmed by randomized, placebo-controlled, double-blind studies in patients with manifest Hepatic Encephalopathy and hyperammonemia. The drug was able to reduce high blood ammonia levels induced either by ammonium chloride or protein ingestion or existing as a clinical complication of cirrhosis per se. Furthermore, OA improved performance in Number Connection Test-A as well as mental state gradation. In contrast to the positive effects observed in patients with more advanced Hepatic Encephalopathy, oral OA does not seem to affect minimal Hepatic Encephalopathy. In a recent trial, OA decreased protein breakdown and stimulated protein synthesis in muscle. The therapy had little side effects, increasing with higher intravenously administered dosages, and was well tolerated after oral and parenteral administration.
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cortical origin of mini asterixis in Hepatic Encephalopathy
Neurology, 2002Co-Authors: Lars Timmermann, Dieter Haussinger, Gerald Kircheis, Joachim Gross, Alfons SchnitzlerAbstract:The authors investigated 12 patients with cirrhosis who had Hepatic Encephalopathy (HE): six with continuous mini-asterixis and six with subclinical HE without asterixis. They studied the coupling between hand-muscle electromyography (EMG) recordings and brain activity recorded by magnetoencephalography. On forearm elevation, patients with tremor developed excessive coupling between activity in the motor cortex (M1) and contralateral hand-muscle EMG recordings at the frequency of mini-asterixis, which was not found in controls. The corticomuscular coupling demonstrates the involvement of M1 in asterixis and may reflect a pathologically slowed and synchronized motor cortical drive.
Robin C. Hilsabeck - One of the best experts on this subject based on the ideXlab platform.
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performance of the Hepatic Encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe Hepatic Encephalopathy
The American Journal of Gastroenterology, 2009Co-Authors: Tarek Hassanein, Jan Stange, Fin Stolze Larsen, Brendan M Mcguire, Stephen H Caldwell, Robert S. Brown, William Perry, Robin C. Hilsabeck, Andres T Blei, Frederik NevensAbstract:Performance of the Hepatic Encephalopathy Scoring Algorithm in a Clinical Trial of Patients With Cirrhosis and Severe Hepatic Encephalopathy
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neuropsychological assessment of Hepatic Encephalopathy ishen practice guidelines
Liver International, 2009Co-Authors: Christopher Randolph, Robin C. Hilsabeck, Ainobu Kato, Parampreet S Kharbanda, Daniela Mapelli, Lisa D Ravdin, Manuel Romerogomez, Andrea Stracciari, Karin WeissenbornAbstract:Low-grade or minimal Hepatic Encephalopathy (MHE) is characterised by relatively mild neurocognitive impairments, and occurs in a substantial percentage of patients with liver disease. The presence of MHE is associated with a significant compromise of quality of life, is predictive of the onset of overt Hepatic Encephalopathy and is associated with a poorer prognosis for outcome. Early identification and treatment of MHE can improve quality of life and may prevent the onset of overt Encephalopathy, but to date, there has been little agreement regarding the optimum method for detecting MHE. The International Society on Hepatic Encephalopathy and Nitrogen Metabolism convened a group of experts for the purpose of reviewing available data and making recommendations for a standardised approach for neuropsychological assessment of patients with liver disease who are at risk of MHE. Specific recommendations are presented, along with a proposed methodology for further refining these assessment procedures through prospective research.
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introduction to the Hepatic Encephalopathy scoring algorithm hesa
Digestive Diseases and Sciences, 2008Co-Authors: Tarek Hassanein, Robin C. Hilsabeck, William PerryAbstract:A primary obstacle to early diagnosis and treatment of Hepatic Encephalopathy (HE) is the lack of a well-validated, standardized assessment method. The purpose of this study was to present preliminary validity data on a new method of grading HE, the Hepatic Encephalopathy Scoring Algorithm (HESA), which combines clinical impressions with neuropsychological performances to characterize HE. Participants were 49 inpatients admitted for complications of end stage liver disease. Each participant’s level of HE was graded using HESA and the West Haven Criteria (WHC) by independent raters blinded to each other’s rating. A moderately strong association was found between the two grading methods (r = 0.60), and individual HESA clinical and neuropsychological indicators were good discriminators among grades. The results also suggest HESA may be more sensitive to mental status impairment in the middle grades of HE than WHC. These findings suggest HESA holds promise as a multi-method approach to grading all levels of HE.
Gerald Kircheis - One of the best experts on this subject based on the ideXlab platform.
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cortical activation associated with asterixis in manifest Hepatic Encephalopathy
Acta Neurologica Scandinavica, 2014Co-Authors: Dieter Haussinger, Markus Butz, Bettina Pollok, Martin Sudmeyer, Gerald Kircheis, Lars Timmermann, Joachim Gross, Alfons SchnitzlerAbstract:Objectives: Severe Hepatic Encephalopathy gives rise to asterixis, a striking motor symptom also called flapping tremor, which is characterized by a sudden ceasing of muscle tone in all muscles of a limb. In this study, we aimed at scrutinizing the cortical activation associated with asterixis and unraveling the underlying pathophysiological mechanisms. Material and methods: We recorded simultaneously neural activity with magnetoencephalography (MEG) and muscle activity with surface EMG in nine patients with manifest Hepatic Encephalopathy showing asterixis. Asterixis events were detected semiautomatically and served as triggers for averaging MEG signals. Evoked responses averaged time-locked to asterixis events were subjected to equivalent current dipole (ECD) modeling. Additionally, we localized the strongest cortico-muscular coherence in the frequency of the co-occurring tremulousness. Results: Evoked fields averaged time-locked to asterixis events were best explained by a single dipolar source in the contralateral primary motor cortex (M1, Talairach coordinates of mean localization: −40, −20, and 64; Brodmann area 4). This dipole showed a twofold field reversal, that is biphasic wave, with frontal dipole orientation at 49 ms before flap onset and 99 ms after flap onset. Conversely, two maxima with occipital dipole orientation were observed 2 ms and 160 ms after flap onset. Cortico-muscular coherence for the tremulousness was likewise localized in the contralateral M1 confirming earlier findings in the present patient cohort. Conclusions: Our results reveal an involvement of M1 in the generation of asterixis. As also tremulousness, also called mini-asterixis, was shown to originate in M1, asterixis and mini-asterixis may share common pathophysiological mechanisms.
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value of critical flicker frequency and psychometric Hepatic Encephalopathy score in diagnosis of low grade Hepatic Encephalopathy
Gastroenterology, 2014Co-Authors: Gerald Kircheis, Norbert Hilger, Dieter HaussingerAbstract:Background & Aims Critical flicker frequency (CFF) and psychometric Hepatic Encephalopathy score (PHES) analyses are widely used to diagnose Hepatic Encephalopathy (HE), but little is known about their value in the diagnosis of low-grade HE. Methods The diagnostic values of CFF and PHES were compared using a computerized test battery and West Haven criteria as reference. We performed CFF analysis on 559 patients with cirrhosis and 261 without (controls). Of these 820 patients, 448 were evaluated using a modified PHES system and 148 were also evaluated using the conventional PHES system. Results CFF distinguished between patients with overt HE and without minimal or overt HE in the entire study population with 98% sensitivity and 94% specificity and in the subgroup of patients who were evaluated by conventional PHES with 97% sensitivity and 100% specificity. Conventional PHES identified patients with overt HE with 73% sensitivity and 89% specificity. CFF distinguished between patients with and without minimal HE with only 37% sensitivity but 94% specificity (entire study population). In the subgroup of patients evaluated by conventional PHES, CFF distinguished between patients with and without minimal HE with 22% sensitivity and 100% specificity; these values were similar to those for conventional PHES (30% sensitivity and 89% specificity). The modified PHES distinguished between patients with and without minimal HE with 49% sensitivity and 74% specificity. The diagnostic agreement values between CFF and conventional or modified PHES in patients with minimal HE were only 54% or 47%, respectively. Conclusions In an analysis of patients with cirrhosis and controls, CFF distinguished between patients with overt HE and without minimal or overt HE. PHES testing produced a statistically significant difference among groups, but there was considerable overlap between controls and patients with overt HE. PHES, CFF, and a combination of PHES and CFF could not reliably distinguish patients with minimal HE from controls or those with overt HE.
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neurotransmitter receptor imbalances in motor cortex and basal ganglia in Hepatic Encephalopathy
Cellular Physiology and Biochemistry, 2009Co-Authors: Nicola Palomerogallagher, George Kostopoulos, Markus Cremer, Hans-jürgen Bidmon, Dieter Haussinger, Axel Schleicher, Guido Reifenberger, Gerald Kircheis, Karl ZillesAbstract:Hepatic Encephalopathy (HE) in chronic liver disease is characterized by neuropsychiatric and motor disturbances and associated with a net increase of inhibitory neurotransmission. Though many studies
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clinical efficacy of l ornithine l aspartate in the management of Hepatic Encephalopathy
Metabolic Brain Disease, 2002Co-Authors: Gerald Kircheis, Matthias Wettstein, Vom S Dahl, Dieter HaussingerAbstract:The clinical efficacy of both oral and parenteral L-ornithine-L-aspartate (OA) was confirmed by randomized, placebo-controlled, double-blind studies in patients with manifest Hepatic Encephalopathy and hyperammonemia. The drug was able to reduce high blood ammonia levels induced either by ammonium chloride or protein ingestion or existing as a clinical complication of cirrhosis per se. Furthermore, OA improved performance in Number Connection Test-A as well as mental state gradation. In contrast to the positive effects observed in patients with more advanced Hepatic Encephalopathy, oral OA does not seem to affect minimal Hepatic Encephalopathy. In a recent trial, OA decreased protein breakdown and stimulated protein synthesis in muscle. The therapy had little side effects, increasing with higher intravenously administered dosages, and was well tolerated after oral and parenteral administration.
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cortical origin of mini asterixis in Hepatic Encephalopathy
Neurology, 2002Co-Authors: Lars Timmermann, Dieter Haussinger, Gerald Kircheis, Joachim Gross, Alfons SchnitzlerAbstract:The authors investigated 12 patients with cirrhosis who had Hepatic Encephalopathy (HE): six with continuous mini-asterixis and six with subclinical HE without asterixis. They studied the coupling between hand-muscle electromyography (EMG) recordings and brain activity recorded by magnetoencephalography. On forearm elevation, patients with tremor developed excessive coupling between activity in the motor cortex (M1) and contralateral hand-muscle EMG recordings at the frequency of mini-asterixis, which was not found in controls. The corticomuscular coupling demonstrates the involvement of M1 in asterixis and may reflect a pathologically slowed and synchronized motor cortical drive.