SpringerLink
Log in

EEG and event related potentials in hepatic encephalopathy

  • Original Contributions
  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

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.

    Google Scholar 

  • Aminoff M.J. (1986). Evoked responses in clinical medicine.Quart J Med 228:345–63.

    Google Scholar 

  • Barber C. (1980).Evoked Potentials, MTP Press, New York.

    Google Scholar 

  • Battgila G., Martini A., Martines D. (1983). Brainstem evoked auditory potentials in the evaluation of hepatic encephalopathy: preliminary data.Minerva Chir 38:1863–6.

    Google Scholar 

  • Berger H. (1929). Uber das Elektrenkephalogramm des Menschen.Archiv Fur Psychiatric und Nervenkrankheiten 87:527–70.

    Google Scholar 

  • Bickford R.G., Butt H.R. (1955). Hepatic coma: the EEG pattern.J Clin Invest 34:790–9.

    Google Scholar 

  • Bodis-Wollner I., Yahr M.D. (1978). Measurement of visual evoked potentials in Parkinson's disease.Brain 101:661–71.

    Google Scholar 

  • 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.

    Google Scholar 

  • Caton R. (1875), The electrical currents of the brain.Brit Med J 2:218.

    Google Scholar 

  • 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.

    Google Scholar 

  • Ciganek L. (1965). A comparative study of visual and auditory EEG responses in man.Brain Research 32:311–5.

    Google Scholar 

  • Chu N-S, Yang S-S, Cheng C-L. (1985). Somatosensory evoked potentials: monitoring cerebral functions following liver transplantation.Clin Electroencephalogr 16:192–4.

    Google Scholar 

  • Chu N-S, Yang S-S. (1987). Brainstem auditory evoked potentials in different types of hepatic disease.Electroencephalogr Clin Neurophysiol 67:337–9.

    Google Scholar 

  • Chu N-S, Yang S-S. (1987). Somatosensory and brainstem evoked potentials in alcoholic liver disease with and without encephalopathy.Alcohol 4:225–30.

    Google Scholar 

  • Chu N-S, Yang S-S. (1988). Portal-systemic encephalopathy alterations in somatosensory and brainstem evoked potentials.J Neurol Sci 84:41–50.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Davis H., Yoshie N. (1963). Human evoked cortical responses to auditory stimuli.Physiologist 6:164–6.

    Google Scholar 

  • Davis P.A. (1939). Effects of acoustic stimulation on the evoking human brain.J Neurophysiol 2:494–6.

    Google Scholar 

  • Dawson G.D. (1954). A summation technique for the detection of small evoked potentials.Electroencephalogr Clin Neurophysiol 6:65–84.

    Google Scholar 

  • Dubois-Reymond E. (1848).Untersuchungen uber tierische Elektricitat. Vol 1. Reimer, Berlin.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Galvani L. (1791). De viribus electricitatis in motu musculari.Commentorius de bonomens scientarium ot artium institutio algue academia commentarii 7:363–418.

    Google Scholar 

  • Gillen W. (1986). The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently ambulant, non-shunted patients with cirrhosis.J Hepatol 3:75–82.

    Google Scholar 

  • 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.

    Google Scholar 

  • Grass A.M., Gibbs F.A. (1938). A fourier transform of the EEG.J Neurophysiol 1:521–4.

    Google Scholar 

  • 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

    Google Scholar 

  • 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.

    Google Scholar 

  • Halliday A.M., Pitman J.R. (1965). A digital computer averager for work on evoked potentials.J Physiol 178:23P.

    Google Scholar 

  • 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.

    Google Scholar 

  • Karnaze D.S., Bickford R.G. (1984). Triphasic waves: a reassessment of their significance.Electroencephal Clin Neurophysiol 57:193–8.

    Google Scholar 

  • 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.

    Google Scholar 

  • Kutas M., McCarthy G., Donchin E. (1972). Augmenting mental chronography: The P300 as a measure of stimulus evaluation time.Science 197:792–5.

    Google Scholar 

  • Laidlaw J. & Reid A.E. (1963). The EEG in Hepatic Encephalopathy.Clin Sci 24:109–20.

    Google Scholar 

  • 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.

    Google Scholar 

  • Myslobodsky M.S., Sharon D., Novis R.H. (1986) Pattern reversal VEP in hepatic cirrhosis.Hepato-gastroenterology 33:145–7.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Parsons-Smith B.G., Summerskill W.H.J., Dawson A.M., Sherlock S. (1957). The EEG in liver disease.Lancet 2:867–71.

    Google Scholar 

  • Pickering G.N. (1960). Conclusion-The Physician. In: Hill A., (ed.) Clinical Trials. Blackwell Oxford, pp.113.

    Google Scholar 

  • 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.

    Google Scholar 

  • Picton T.W., Woods D.L., Baribeau-Braun J. (1977). Evoked Potential Audiometry.J of Otolaryngology 6:90–118.

    Google Scholar 

  • Pozzessere G., Valle E., Mollica M.A. (1988). Brainstem auditory evoked potentials in toxic metabolic and anoxic coma. Riv Neurol58:183–8.

    Google Scholar 

  • Pritchard W.S. (1981). Psychophysiology of P300.Psychol Bull 89:506–40.

    Google Scholar 

  • Reiher J. (1970) The EEG in the investigation of metabolic comas.Electroencephal Clin Neurophysiol 58:104P.

    Google Scholar 

  • Rikkers L., Jenko P., Rudman D., Freides D. (1978). Subclinical hepatic encephalopathy: detection, prevalence and relationship to nitrogen metabolism.Gastroenterology 75:462–9.

    Google Scholar 

  • Sandford N.L., Saul R.E. (1988) Assessment of hepatic encephalopathy with visual evoked potentials compared with conventional methods.Hepatology 8:1094–8.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Sherlock S. (1977). Hepatic encephalopathy.Brit J Hosp Med 17:144–6.

    Google Scholar 

  • Sherlock S. (1981). Hepatic encephalopathy. In: Sherlock S. (ed).Diseases of the liver and biliary system. Blackwell Scientific Publications, Oxford, pp.91–115.

    Google Scholar 

  • Silk D.B.A.. Acute liver failure. (1979).Brit J Hosp Med 22:437–9.

    Google Scholar 

  • Simarian J.P., Harper R.W. (1974). Diagnosis of metabolic encephalopathy: significance of triphasic waves in the electroencephalogram.Neurology 22:456A.

    Google Scholar 

  • 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.

    Google Scholar 

  • Sutton S., Braren M., Zubin J., John E.R. (1965). Evoked potential correlates of stimulus uncertainty.Science 150:1187–8.

    Google Scholar 

  • 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.

    Google Scholar 

  • Van der Rijt C.D., Schalm S.W. (1985). Quantitative EEG analysis and survival in liver disease.Electroencephalogr Clin Neurophysiol 61:502–5.

    Google Scholar 

  • Vaughan H., Ritter W. (1970). The sources of the AER recorded from the human scalp.Electroencephalogr Clin Neurophysiol 28:360–7.

    Google Scholar 

  • Walter W.G. (1943). An automatic low frequencybanalyser.Electronic Engineering 16:8–12.

    Google Scholar 

  • Wever E.G., Bray C.D. (1930). Auditory nerve impulse.Science 21:215–6.

    Google Scholar 

  • 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.

    Google Scholar 

  • Yang S-S., Chu N-S., Liaw Y-F. (1985). Somatosensory evoked potentials in hepatic encephalopathy.Gastroenterology 59:625–30.

    Google Scholar 

  • Yang S-S., Chu N-S., Liaw Y-F. (1986). Brainstem auditory potentials in hepatic encephalopathy.Hepatology 6:1352–5.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Zeneroli M.L. (1985) Hepatic encephalopathy: experimental studies in a rat model of fulminant hepatic failure.J Hepatol 1:301–12.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology and Therapeutics, Trinity College and St. James's Hospital, Dublin, Ireland

    Mark G. Davies, Michael J. Rowan & John Feely

Authors
  1. Mark G. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael J. Rowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Feely
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00996917

Key words

Search

Navigation