Abstract
In recent years, there have been considerable developments in the application of EEG and event related potential technology to the diagnosis and assessment of hepatic encephalopathy in cirrhotic patients. A review of the literature on this subject is reported. The visually interpreted EEG is only of benefit in the late stages of hepatic encephalopathy. EEG spectral analysis allows identification of all stages of the condition. Brainstem auditory evoked responses are normal in encephalopathy. Visual evoked responses show an increase in the latency and eventual loss of individual component waves as encephalopathy progresses. Somatosensory evoked responses show a progressive prolongation of peak and inter-peak latency which correlates with the severity of encephalopathy. The auditory P300 evoked response shows an increased latency with the development of hepatic encephalopathy. Event related potentials provide objective diagnostic markers of the development of hepatic encephalopathy. The increased use of this technology in the assessment of patients with this condition should be of clinical benefit in its management.
Similar content being viewed by others
References
Adams R.D., Foley J.M. (1953). The neurological disorder associated with liver disease. In:Metabolic and Toxic Diseases of the Nervous System. Williams and Wilkins, Baltimore, pp. 198–237.
Aminoff M.J. (1986). Evoked responses in clinical medicine.Quart J Med 228:345–63.
Barber C. (1980).Evoked Potentials, MTP Press, New York.
Battgila G., Martini A., Martines D. (1983). Brainstem evoked auditory potentials in the evaluation of hepatic encephalopathy: preliminary data.Minerva Chir 38:1863–6.
Berger H. (1929). Uber das Elektrenkephalogramm des Menschen.Archiv Fur Psychiatric und Nervenkrankheiten 87:527–70.
Bickford R.G., Butt H.R. (1955). Hepatic coma: the EEG pattern.J Clin Invest 34:790–9.
Bodis-Wollner I., Yahr M.D. (1978). Measurement of visual evoked potentials in Parkinson's disease.Brain 101:661–71.
Borg J., Warters J.M., Schlienger J.L., Imler M., Mareseaux C., Mack G. (1982). Neurotransmitter modifications in human cerebro spinal fluid and serum during hepatic encephalopathy.J Neurol Sci 57:343–56.
Caton R. (1875), The electrical currents of the brain.Brit Med J 2:218.
Carroll W.M., Kriss A., Baraitsu M., Barrett G., Halliday A.M. (1980). The incidence and nature of visual pathway involvement in Friedreichson's Ataxia: a clinical and visual evoked potential study of 22 patients.Brain 103:413–34.
Ciganek L. (1965). A comparative study of visual and auditory EEG responses in man.Brain Research 32:311–5.
Chu N-S, Yang S-S, Cheng C-L. (1985). Somatosensory evoked potentials: monitoring cerebral functions following liver transplantation.Clin Electroencephalogr 16:192–4.
Chu N-S, Yang S-S. (1987). Brainstem auditory evoked potentials in different types of hepatic disease.Electroencephalogr Clin Neurophysiol 67:337–9.
Chu N-S, Yang S-S. (1987). Somatosensory and brainstem evoked potentials in alcoholic liver disease with and without encephalopathy.Alcohol 4:225–30.
Chu N-S, Yang S-S. (1988). Portal-systemic encephalopathy alterations in somatosensory and brainstem evoked potentials.J Neurol Sci 84:41–50.
Creutzfeld O.D., Kuhnt U., Benerento L.A. (1974). An intercellular analysis of visual cortical neurones to moving stimuli; a response to a cooperative neuronal network.Expt Brain Research 21:251–60.
Davies M.G., Rowan M.J., Keeling P.W.N., Weir D.G., Feely J. (1990). The auditory P300 event related potental: an objective marker of the encephalopathy of chronic liver disease.Hepatology 12:688–94.
Davies M.G., Rowan M. J., Feely J. (1990). Flash visual evoked responses in the early encephalopathy of chronic liver disease.Scand J Gastroenterol 25:1205–14.
Davis H., Davis P.A., Loomis A.L. (1939). Electrical reactions of the human brain to auditory stimulation during sleep.J Neurophysiol 2:500–1.
Davis H., Yoshie N. (1963). Human evoked cortical responses to auditory stimuli.Physiologist 6:164–6.
Davis P.A. (1939). Effects of acoustic stimulation on the evoking human brain.J Neurophysiol 2:494–6.
Dawson G.D. (1954). A summation technique for the detection of small evoked potentials.Electroencephalogr Clin Neurophysiol 6:65–84.
Dubois-Reymond E. (1848).Untersuchungen uber tierische Elektricitat. Vol 1. Reimer, Berlin.
Ferenci P., Pappas S.C., Munson P.J., Henson K., Jones E.A. (1984). Changes in the status of neurotransmitter receptors in rabbit model of hepatic encephalopathy.Hepatology 4:186.
Ferenci P., Grimm G., Heryn S., Gangl A. (1989). Successful long term treatment of portal-systemic encephalopathy by the benzodiazepine antagonist Flumazenil.Gastroenterology 96:240–3.
Foley J.M., Watson C.W., Adams R.D. (1950). Significance of the EEG changes in hepatic coma.Trans Amer Neurol Assoc 75:161–4.
Galvani L. (1791). De viribus electricitatis in motu musculari.Commentorius de bonomens scientarium ot artium institutio algue academia commentarii 7:363–418.
Gillen W. (1986). The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently ambulant, non-shunted patients with cirrhosis.J Hepatol 3:75–82.
Gloor P. (1969). Hans Berger on the EEG of man.Electroencephal Clin Neurophysiol Suppl 28.
Goff W.B., Allison T., Vaughen H. (1977). The functional neuroanatomy of the ERP. In: Calloway E., Tueting P., Koslov S.H. (eds.),ERP in man, Academic Press, New York.
Grass A.M., Gibbs F.A. (1938). A fourier transform of the EEG.J Neurophysiol 1:521–4.
Grimm G., Lenz K., Kleinberger G. (1987). Ro 15-1788 improves coma in 4 out of 5 patients with fulminant hepatic failure: verification by long latency auditory and somatosensory potentials.JHepatol 4 (suppl 1):S21
Grimm G., Ferenci P., Katzenschlager R., Madl C., Schneeweiss B., Laggner A.N., Lenz K., Gangl A. (1988). Improvement of hepatic encephalopathy treated with Flumazenil.Lancet 2:1392–4.
Halliday A.M., Pitman J.R. (1965). A digital computer averager for work on evoked potentials.J Physiol 178:23P.
Jewett D.L. (1970). Volume-conducted potentials in response to auditory stimuli as detected by averaging in the cat.Electroencephalogr Clin Neurophysiol 28:609–11.
Karnaze D.S., Bickford R.G. (1984). Triphasic waves: a reassessment of their significance.Electroencephal Clin Neurophysiol 57:193–8.
Kennedy J., Parbhoro S., McGillinany B., Sherlock S. (1973). Effect of extracorporal perfusion on the EEG of patients in coma due to acute liver failure.Quart J Meet 167:549–61.
Kutas M., McCarthy G., Donchin E. (1972). Augmenting mental chronography: The P300 as a measure of stimulus evaluation time.Science 197:792–5.
Laidlaw J. & Reid A.E. (1963). The EEG in Hepatic Encephalopathy.Clin Sci 24:109–20.
Levy L.J., Bolton R.P., Losowsky M.S. (1987). The use of VEP in delineating a state of subclinical encephalopathy.J Hepatol 5:211–7.
Myslobodsky M.S., Sharon D., Novis R.H. (1986) Pattern reversal VEP in hepatic cirrhosis.Hepato-gastroenterology 33:145–7.
Paiva T., Cravo M. (1988). Multimodal evoked potentials in subclinical hepatic encephalopathy. In: Soeters PB, Wilson J.H.P., Meijer A.J., Holm E., (eds.),Advances in ammonia metabolism and hepatic encephalopathy. Elsevier Science Publishers,Amsterdam, pp. 373–81.
Paiva T., Fred A., Nunes-Leitao J. (1988). EEG and VER map** in some metabolic disease. In: Statistics and topography in quantitative EEG.Elsevier Science Publishers, Paris, pp. 237–41.
Pappas S.C., Ferenci P., Schafer D.E., Jones E.A. (1984). Visual evoked potentials in a rabbit model of hepatic encephalopathy (II).Gastroenterology 86:546–51.
Parsons-Smith B.G., Summerskill W.H.J., Dawson A.M., Sherlock S. (1957). The EEG in liver disease.Lancet 2:867–71.
Pickering G.N. (1960). Conclusion-The Physician. In: Hill A., (ed.) Clinical Trials. Blackwell Oxford, pp.113.
Pierelli F., Pozzessere G., Sanarelli L., Valle E., Rizzo PA, Morocutti C. (1985). Electrophysiological study in patients in chronic hepatic insufficiency.Acta Neurol Belg 85:284.
Picton T.W., Woods D.L., Baribeau-Braun J. (1977). Evoked Potential Audiometry.J of Otolaryngology 6:90–118.
Pozzessere G., Valle E., Mollica M.A. (1988). Brainstem auditory evoked potentials in toxic metabolic and anoxic coma. Riv Neurol58:183–8.
Pritchard W.S. (1981). Psychophysiology of P300.Psychol Bull 89:506–40.
Reiher J. (1970) The EEG in the investigation of metabolic comas.Electroencephal Clin Neurophysiol 58:104P.
Rikkers L., Jenko P., Rudman D., Freides D. (1978). Subclinical hepatic encephalopathy: detection, prevalence and relationship to nitrogen metabolism.Gastroenterology 75:462–9.
Sandford N.L., Saul R.E. (1988) Assessment of hepatic encephalopathy with visual evoked potentials compared with conventional methods.Hepatology 8:1094–8.
Sandford S.L., Tarter R.E., Sclabassi R., Van Thiel D. (1987). Sensory information processing in patients with non-alcoholic cirrhosis.J Neuro Sciences 80:267–76.
Schafer D.F., Pappas S.C., Brody L.E., Jacobs R., Jones E.A. (1984) Visual evoked potentials in a rabbit model of hepatic encephalopathy (I).Gastroenterology 86:540–5.
Shagass C., Straumanis J.J., Rohmer R., Amadzo M. (1977). ERP and Psychopathology. In: Calloway E., Tueting P., Koslow S.H., (eds.).Event related brain potentials in man. Academic Press, New York.
Shagass C., Straumanis J.J. (1978). Drugs and human sensory evoked potentials. In: Lipton M.A., DiMascio A., (eds.),Psychopharmcology: a generation of progress. Raven Press, New York, pp. 699–728.
Sherlock S. (1977). Hepatic encephalopathy.Brit J Hosp Med 17:144–6.
Sherlock S. (1981). Hepatic encephalopathy. In: Sherlock S. (ed).Diseases of the liver and biliary system. Blackwell Scientific Publications, Oxford, pp.91–115.
Silk D.B.A.. Acute liver failure. (1979).Brit J Hosp Med 22:437–9.
Simarian J.P., Harper R.W. (1974). Diagnosis of metabolic encephalopathy: significance of triphasic waves in the electroencephalogram.Neurology 22:456A.
Strom VanLeuvan W. (1975). Auditory evoked responses. In: Redmond A (ed.),Handbook of EEG and Clinical Neurophysiology Amsterdam. Vol 8A 1975.
Summerskill H.J., Davidson E.A., Sherlock S., Steiner R.E. (1956). The neuropsychiatric syndrome associated with hepatic cirrhosis and extensive portal collateral circulation.Quart J Med 25:245–7.
Sutton S., Braren M., Zubin J., John E.R. (1965). Evoked potential correlates of stimulus uncertainty.Science 150:1187–8.
Van der Rijt C.D., Schalm S.W., De Groot G.H., De Vlieger M. (1984). Objective measurements of hepatic encephalopathy by means of activated EEG analysis.Electroencephalogr Clin Neurophysiol 57:423–6.
Van der Rijt C.D., Schalm S.W. (1985). Quantitative EEG analysis and survival in liver disease.Electroencephalogr Clin Neurophysiol 61:502–5.
Vaughan H., Ritter W. (1970). The sources of the AER recorded from the human scalp.Electroencephalogr Clin Neurophysiol 28:360–7.
Walter W.G. (1943). An automatic low frequencybanalyser.Electronic Engineering 16:8–12.
Wever E.G., Bray C.D. (1930). Auditory nerve impulse.Science 21:215–6.
Weissenborn K., Scholz M., Hinrichs H., Wiltfang J., Schmidt F.W., Kunkei H. (1990). Neurophysiological assessment of early hepatic encephalopathy.Electroencephalogr Clin Neurophysiol 75:289–95.
Yang S-S., Chu N-S., Liaw Y-F. (1985). Somatosensory evoked potentials in hepatic encephalopathy.Gastroenterology 59:625–30.
Yang S-S., Chu N-S., Liaw Y-F. (1986). Brainstem auditory potentials in hepatic encephalopathy.Hepatology 6:1352–5.
Yen C-L., Liaw Y-F. (1990). Somatosensory evoked potentials and number connection test in the detection of subclinical hepatic encephalopathy.Hepato-gastroenterol 37:332–334.
Zeegan R., Drinkwater J.E., Dawson A.M. (1970). Methods for measuring cerebral dysfunction in patients with liver disease.Brit J Med 1:633–6.
Zeneroli M.L., Pinelli G., Gallini G., Penne A., Messori E., Zani G., Ventura E. (1984). VEP: a diagnostic tool for the assessment of hepatic encephalopathy.Gut 25:291–9.
Zeneroli M.L. (1985) Hepatic encephalopathy: experimental studies in a rat model of fulminant hepatic failure.J Hepatol 1:301–12.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Davies, M.G., Rowan, M.J. & Feely, J. EEG and event related potentials in hepatic encephalopathy. Metab Brain Dis 6, 175–186 (1991). https://doi.org/10.1007/BF00996917
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00996917