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Patients with manifest hepatic encephalopathy can reveal impaired thermal perception
Author(s) -
Brenner M.,
Butz M.,
May E. S.,
Kahlbrock N.,
Kircheis G.,
Häussinger D.,
Schnitzler A.
Publication year - 2015
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12376
Subject(s) - quantitative sensory testing , audiology , medicine , cirrhosis , sensory threshold , flicker fusion threshold , two alternative forced choice , sensory system , somatosensory system , hepatic encephalopathy , psychology , physical medicine and rehabilitation , neuroscience , psychiatry , flicker , cognitive psychology , electrical engineering , engineering , cognitive science
Objectives Previous evoked potential studies indicated central impairments of somatosensory function in patients suffering from hepatic encephalopathy ( HE ). The aim of this study was to quantify the somatosensory perception in patients with minimal and overt HE . Materials and Methods Forty‐two patients with liver cirrhosis and HE up to grade 2 and 12 age‐matched healthy controls underwent a comprehensive graduation of HE including the West Haven criteria , the critical flicker frequency ( CFF ), and neuropsychometric testing. Quantitative sensory testing, standardized by the German Research Network on Neuropathic Pain , was performed on both hands. Results Pain and mechanical detection thresholds were unchanged in HE . Tests of thermal processing revealed that patients with HE of grade 2 perceive cold at lower temperatures (cold detection threshold) and need a higher temperature difference to distinguish between warm and cold (thermal sensory limen). These impairments correlated with the CFF . A correction for attention deficits by performing partial correlations using neuropsychometric test results canceled these correlations. Conclusions The present findings demonstrate an impairment of temperature perception in HE . The extent of this impairment correlates with HE severity as quantified by the CFF . The attenuation of the correlations after correction for attention deficits suggests a strong role of attention deficits for the impaired thermal perception. Thus, it provides initial evidence for a central impairment of thermal processing in HE due to alterations in high‐level processes rather than due to peripheral neuropathic processes, which are a frequent complication in patients with liver cirrhosis.