scholarly journals A Current Review of the Diagnostic and Treatment Strategies of Hepatic Encephalopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Z. Poh ◽  
P. E. J. Chang
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Benzodiazepine Receptor ◽  
Minimal Hepatic Encephalopathy ◽  
Current Treatment ◽  
Translocator Protein ◽  
Diagnostic Tools ◽  
Neuropsychiatric Manifestations

Hepatic encephalopathy (HE) is a serious and potentially fatal complication in patients with cirrhotic liver disease. It is a spectrum ranging from minimal hepatic encephalopathy (MHE) without recognizable clinical symptoms or signs, to overt HE with risk of cerebral edema and death. HE results in diminished quality of life and survival. The broad range of neuropsychiatric manifestations reflects the range of pathophysiological mechanisms and impairment in neurotransmission that are purported to cause HE including hyperammonemia, astrocyte swelling, intra-astrocytic glutamine, upregulation of 18-kDa translocator protein (TSPO) (formerly known as peripheral benzodiazepine receptor or PBTR), and manganese. There is a myriad of diagnostic tools including simple bedside clinical assessment, and more complex neuropsychological batteries and neurophysiological tests available today. Current treatment strategies are directed at reducing ammonia, with newer agents showing some early promise. This paper describes the pathophysiology of the disease and summarises current diagnostic and treatment therapies available.

Diagnosis and treatment of hepatic encephalopathy

2013 ◽  
Vol 20 (1) ◽  
pp. 1-11
Author(s):  
Ilona Savlan ◽  
Valentina Liakina ◽  
Jonas Valantinas
Keyword(s):  
Quality Of Life ◽  
Hepatic Encephalopathy ◽  
Treatment Strategies ◽  
Cognitive Disorders ◽  
Minimal Hepatic Encephalopathy ◽  
Secondary Importance ◽  
First Choice ◽  
Cirrhotic Patients ◽  
Branched Chain

Background. Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver cirrhosis which symptoms may vary from imperceptible to severe ones. In recent years, there have been some changes of fundamental hepatic encephalopathy pathogenesis and treatment. The early HE on the stage of minimal hepatic encephalopathy (MHE) is rarely diagnosed and treatable condition worldwide and in Lithuania as well, however, this HE stage is responsible for the cognitive disorders which impair the quality of life of cirrhotic patients. According to resent data, MHE can be diagnosed in up to 70% of cirrhotic patients. Aim. To evaluate new diagnostic and treatment strategies for HE and especially MHE for further use in clinical practice to cure the quality of life of cirrhotic patients and prevent clinical manifestation of HE. Methods and materials. This article is based on relevant original publications and reviews in English (1991–2012) that were retrieved by a selective key word based search in the Medline and PubMed databases. Results. It is recommended not to decrease an amount of proteins in food and consume products containing more branched-chain amino acids. Non-absorbable disaccharides (lactulose) are still the drugs of the first choice, though recent data show significant concerns about their effectiveness. Rifaximin is increasingly used all over the world for hepatic encephalopathy treatment. Other drugs for HE treatment are of secondary importance. Lactulose, probiotics are recommended for minimal hepatic encephalopathy treatment. Diagnosis, especially of minimal hepatic encephalopathy, remains complicated. There are no reliable and validated blood indicators to establish minimal hepatic encephalopathy diagnosis, and to follow up treatment efficacy. Psychometric and neurophysiologic methods, visualisation methods are used more in scientific researches. Computerized methods, such as inhibitory control and critical flicker frequency tests, are also promising. Conclusions. Further studies are necessary to design proper algorithms of hepatic encephalopathy diagnostic and treatment.

Whole brain atlas-based diffusion kurtosis imaging parameters for evaluation of minimal hepatic encephalopathy

2021 ◽  
pp. 197140092110269
Author(s):  
Prateek Gupta ◽  
Sameer Vyas ◽  
Teddy Salan ◽  
Chirag Jain ◽  
Sunil Taneja ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Imaging Techniques ◽  
Clinical Stage ◽  
Minimal Hepatic Encephalopathy ◽  
Brain Atlas ◽  
Diffusion Kurtosis Imaging ◽  
Whole Brain ◽  
Diffusion Kurtosis

Background and purposes Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms, but patients have cognitive and psychomotor deficits. Hyperammonemia along with neuroinflammation lead to microstructural changes in cerebral parenchyma. Changes at conventional imaging are detected usually at the overt clinical stage, but microstructural alterations by advanced magnetic resonance imaging techniques can be detected at an early stage. Materials and methods Whole brain diffusion kurtosis imaging (DKI) data acquired at 3T was analyzed to investigate microstructural parenchymal changes in 15 patients with MHE and compared with 15 age- and sex-matched controls. DKI parametric maps, namely kurtosis fractional anisotropy (kFA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK), were evaluated at 64 white matter (WM) and gray matter (GM) regions of interest (ROIs) in the whole brain and correlated with the psychometric hepatic encephalopathy score (PHES). Results The MHE group showed a decrease in kFA and AK across the whole brain, whereas MK and RK decreased in WM ROIs but increased in several cortical and deep GM ROIs. These alterations were consistent with brain regions involved in cognitive function. Significant moderate to strong correlations (–0.52 to –0.66; 0.56) between RK, MK and kFA kurtosis metrics and PHES were observed. Conclusion DKI parameters show extensive microstructural brain abnormalities in MHE with minor correlation between the severity of tissue damage and psychometric scores.

scholarly journals Neuropsychiatric symptoms in Parkinson's disease: aetiology, diagnosis and treatment

2020 ◽  
Vol 26 (6) ◽  
pp. 333-342 ◽  
Author(s):  
Shoned Jones ◽  
Kelli M. Torsney ◽  
Lily Scourfield ◽  
Katie Berryman ◽  
Emily J. Henderson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neuropsychiatric Symptoms ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Motor Disorder ◽  
Dopamine Dysregulation Syndrome ◽  
Disease Aetiology ◽  
Neuropsychiatric Manifestations ◽  
Assessment Scales

SUMMARYHistorically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.

Anosmia: Differential Diagnosis, Evaluation, and Management

2017 ◽  
Vol 31 (1) ◽  
pp. e3-e7 ◽  
Author(s):  
George A. Scangas ◽  
Benjamin S. Bleier
Keyword(s):  
Differential Diagnosis ◽  
Negative Impact ◽  
Treatment Strategies ◽  
Communication Disorders ◽  
The United States ◽  
Current Treatment ◽  
Olfactory Dysfunction ◽  
Olfactory Testing ◽  
Smell Disorders

The ability to scrutinize our surroundings remains heavily dependent on the sense of smell. From the ability to detect dangerous situations such as fires to the recollection of a fond memory triggered by an odor, the advantages of an intact olfactory system cannot be overstated. Outcomes studies have highlighted the profound negative impact of anosmia and parosmia on the overall quality of life. The National Institute on Deafness and Other Communication Disorders estimates that ∼1.4% of the United States population experiences chronic olfactory dysfunction and smell loss. Efforts have focused on improving both the diagnosis of olfactory dysfunction through olfactory testing and improved reporting of treatment outcomes of olfactory training. The purpose of this article was to review the differential diagnosis, workup, and current treatment strategies of anosmia and smell disorders.

scholarly journals Role of high dose octreotide LAR for the treatment of GEP-NETs

2009 ◽  
Vol 3 (1) ◽  
pp. 7-14
Author(s):  
Giulia M. Franchi ◽  
Chiara Cappelletti ◽  
Valentina V. Villa ◽  
Emanuele Bosi ◽  
Marco F. Manzoni
Keyword(s):  
Quality Of Life ◽  
Tumour Growth ◽  
Neuroendocrine Tumours ◽  
Clinical Symptoms ◽  
Standard Dose ◽  
Diagnostic Tools ◽  
High Dose ◽  
Octreotide Lar

Neuroendocrine Tumours (NETs) are a heterogeneous group of rare neoplasms that account for 0,5% of all malignancies. The increased incidence observed in the last few decades may be accounted for by increased awareness, improved diagnostic tools and a revision in the definition. The main primary sites are the gastro-entero-pancreatic (GEP) tract (62-67%), and the lung (22-27%). In patients with GEP-NETs, the strongest predictor of 5-years survival is the staging. An adequate clinical management of GEP-NETs should be multidisciplinary and should aim at assuring a good quality of life. Somatostatin (sst) analogues are widely used in these tumours, which often express sst receptors, since they are demonstrated to reduce clinical symptoms and tumour growth. Herein we explore the usefulness of doubling octreotide LAR dose in selected patients after escaping from symptoms control and/or tumour stabilization in course of treatment with standard dose.

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