Brief Reports
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World J Gastroenterol. May 14, 2005; 11(18): 2777-2780
Published online May 14, 2005. doi: 10.3748/wjg.v11.i18.2777
Diagnostic value of fine motor deficits in patients with low-grade hepatic encephalopathy
Sergei Mechtcheriakov, Ivo W. Graziadei, Maria Rettenbacher, Ingrid Schuster, Hartmann Hinterhuber, Wolfgang Vogel, Josef Marksteiner
Sergei Mechtcheriakov, Ingrid Schuster, Hartmann Hinterhuber, Josef Marksteiner, Department of General Psychiatry, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
Ivo W. Graziadei, Wolfgang Vogel, Department of Gastroenterology and Hepatology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
Maria Rettenbacher, Department of Biological Psychiatry, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Sergei Mechtcheriakov, Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. s.mechtcheriakov@uibk.ac.at
Telephone: +43-512-504-23636 Fax: +43-512-504-23628
Received: November 18, 2004
Revised: November 19, 2004
Accepted: December 20, 2004
Published online: May 14, 2005
Abstract

AIM: The role of motor dysfunction in early diagnosis of low-grade hepatic encephalopathy remains uncertain. We performed a pilot study to comparatively investigate the kinematic characteristics of small and large rapid alternating movements in patients with liver cirrhosis and low-grade hepatic encephalopathy.

METHODS: A kinematic analysis of alternating handwriting (7.5 mm) and large drawing movements (DM, 175 mm) was performed in 30 patients with liver cirrhosis (no hepatic encephalopathy: n = 10; minimal hepatic encephalopathy: n = 9; grade I hepatic encephalopathy: n = 11; healthy controls: n = 12). The correlation between kinematic parameters, clinical neuro-psychiatric symptoms of cerebral dysfunction and the grade of encephalopathy was investigated.

RESULTS: Both movement types, handwriting and drawing, were significantly slower in cirrhotic patients. In contrast to large DM, the deterioration of handwriting movements significantly correlated with the increase of symptoms of motor dysfunction and differentiated significantly within the group of cirrhosis patients corresponding to the degree of hepatic encephalopathy.

CONCLUSION: The deterioration of fine motor control is an important symptom of low-grade hepatic encephalopathy. The kinematic analysis of handwriting allows the quantitative analysis of alterations of motor function and is a possible tool for diagnostics and monitoring of motor dysfunction in patients with low-grade hepatic encephalopathy.

Keywords: Hepatic encephalopathy; Liver cirrhosis; Motor dysfunction; Handwriting; Kinematic analysis