Hanaa Mostafa El-Karaksy1,2, Omneya Afifi3, Azza Bakry4, Ann Abdel Kader5, Noha Saber4. 1. Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt. hanaakaraksy@kasralainy.edu.eg. 2. , 44 Mohei El-Deen Abu El-Ezz Street, Dokki, Cairo, 12311, Egypt. hanaakaraksy@kasralainy.edu.eg. 3. Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt. 4. Department of Psychiatry, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt. 5. Department of Neurophysiology, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt.
Abstract
BACKGROUND: Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE. METHODS: A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP). RESULTS: The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea. CONCLUSIONS: This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.
BACKGROUND: Minimal hepatic encephalopathy (MHE) is not associated with overt neuropsychiatric symptoms but rather with subtle changes in psychometric and/or neurophysiologic tests. We aimed to diagnose MHE in children with extrahepatic portal vein obstruction (EHPVO) and to evaluate the effect of lactulose on MHE. METHODS: A prospective study was carried out on 30 patients with EHPVO (21 males; mean age 10±2.5 years). The study was carried out in the Pediatric Hepatology Unit, Cairo University Pediatric Hospital, Cairo, Egypt, between 2011 and 2013. All patients were subjected to clinical and laboratory assessment, neuropsychmetric testing using the arabic version of Wechsler intelligence tests, neurophysiological testing by visual electroencephalogram and P300 event related potentials (ERP). RESULTS: The prevalence of MHE among children with EHPVO was 20% (6/30). After randomization to treatment and no-treatment groups using lactulose, all tests were repeated after three months. Among four patients with MHE who received lactulose, three (75%) improved. On the other hand, one of the patients in the no-treatment group developed MHE. Only one patient in the treatment arm had to discontinue lactulose because of severe diarrhea. CONCLUSIONS: This pilot study revealed that the prevalence of MHE was 20%. Improvement on psychometic tests was seen in 75% of our patients (3/4) after treatment with lactulose. Lactulose treatment was well tolerated.
Authors: Peter Ferenci; Alan Lockwood; Kevin Mullen; Ralph Tarter; Karin Weissenborn; Andres T Blei Journal: Hepatology Date: 2002-03 Impact factor: 17.425
Authors: Beatriz Mínguez; Juan Carlos García-Pagán; Jaume Bosch; Juan Turnes; Juli Alonso; Alex Rovira; Juan Córdoba Journal: Hepatology Date: 2006-04 Impact factor: 17.425
Authors: Christopher Randolph; Robin Hilsabeck; Ainobu Kato; Parampreet Kharbanda; Yu-Yuan Li; Daniela Mapelli; Lisa D Ravdin; Manuel Romero-Gomez; Andrea Stracciari; Karin Weissenborn Journal: Liver Int Date: 2009-03-19 Impact factor: 5.828