Analysis of critical flicker frequency threshold in hepatic encephalopathy: dynamics and cortical activations

  • G. Kircheis
  • O. Zafiris
  • H-A. Rood
  • F. Boers
  • K. Zilles
  • D. Häussinger

Abstract

Critical flicker frequency (CFF) is a reproducible determination for quantification of the severity of hepatic encephalopathy (HE) in cirrhotic patients. It is not affected appreciably by training. CFFs change consistently in parallel with the evolution of HE after transjugular intrahepatic portal-systemic stent (TIPSS) placement. CFF determination is suitable for monitoring fluctuations in the severity of HE in response to precipitating factors or therapeutical intervention. A correlation between CFF threshold and impairment of attentional-executive and decision-making cortical networks, demonstrated by event-related functional magnet resonance imaging (efMRI), was found in minimal HE (mHE) and overt HE. The activated brain areas during CFF threshold detection correspond to the activated cortical networks described previously in positron emission tomography (PET) studies of cirrhotic patients with HE. Standardized CFF detection was found to be a sensitive, reproducible and objective determination for quantifying the short and long-term evolution of mHE and overt HE.

Keywords

Retina Glutamine Sine Peritonitis Kato 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Norenberg MD, Baker L, Norenberg MD et al. Ammonia-induced astrocyte swelling in primary culture. NeurochemRes 1991; 16: 833–836.CrossRefGoogle Scholar
  2. 2.
    Riepe RE and Norenberg MD. Müller cell localization of glutamine synthetase in rat retina. Nature 1977; 268: 654–655.PubMedCrossRefGoogle Scholar
  3. 3.
    Reichenbach A, Fuchs U, Kasper M, El-Hifnawi E, and Eckstein AK. Hepatic retinopathy: morphological features of retinal glial (Müller) cells accompanying hepatic failure. Acta Neuropathol 1995; 90: 273–281.PubMedCrossRefGoogle Scholar
  4. 4.
    Eckstein AK, Reichenbach A, Jacobi P, Gregor M, and Zrenner E. Hepatic retinopathia: changes in retinal function. Vision Res. 1997; 37:1699–1706.PubMedCrossRefGoogle Scholar
  5. 5.
    Kircheis G, Wettstein M, Timmermann L, Schnitzler A and Häussinger D. Critical flicker frequency for quantification of low-grade hepatic encephalopathy. Hepatology 2002; 35: 357–366.PubMedCrossRefGoogle Scholar
  6. 6.
    Rikkers L, Jenko P, Rudman D and Freides D. Subclinical hepatic encephalopathy: detection, prevalance and relationship to nitrogen metabolism. Gastroenterology 1978; 75: 462–469.PubMedGoogle Scholar
  7. 7.
    Gitlin N, Lewis DC and Hinkley L. The diagnosis and prevalence of subclinical hepatic encephalopathy in apparently healthy, ambulant, non-shunted patients with cirrhosis. J Hepatol 1986; 3: 75–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Conn HO. Quantifying the severity of hepatic encephalopathy. In: Conn HO, Bircher J (Eds). Hepatic Encephalopathy: Syndromes and Therapies. East Lansing, Michigan, Medi-Ed Press, 1993: 13–26.Google Scholar
  9. 9.
    Weissenborn K, Ermen JC, Schomerus H, Rückert N, and Hecker H. Neuropsychological characterization of hepatic encephalopathy. J Hepatol 2001; 34: 768–773.PubMedCrossRefGoogle Scholar
  10. 10.
    Groeneweg M, Moerland W, Quero JC, Hop WCJ, Krabbe PF and Schalm S. Screening of subclinical hepatic encephalopathy. J Hepatol 2000; 32: 748–753.PubMedCrossRefGoogle Scholar
  11. 11.
    Conn HO. Trailmaking and number connection tests in the assessment of mental state in portal systemic encephalopathy. Am. J. Dig. Dis. 1977; 22: 541–550.PubMedCrossRefGoogle Scholar
  12. 12.
    Weissenborn K, Rückert N, Hecker H, and Manns MP. The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy. J Hepatology 1998; 28: 646–653.CrossRefGoogle Scholar
  13. 13.
    Schomerus H, Weissenborn K, Hamster W, Rückert N and Hecker H. PSE-Syndrom-Test Manual. Swet Test Services, Frankfurt, 1999.Google Scholar
  14. 14.
    Watanabe A, Kuwabara Y, Okita H and Kato A. Computer-assisted quantitative neuropsychological tests for early detection of subclinical hepatic encephalopathy in patients with liver cirrhosis. Res Commun Biol Psychol Psychiat 1997; 22: 25–38.Google Scholar
  15. 15.
    Vienna test system (WINWTS), Version 4.50, Dr. G. Schuhfried GmbH, Mödling, Austria (1999)Google Scholar
  16. 16.
    Wollersdorf E and Barolin GS. Fhrnmerverschmelzungsfrequenzanalyse in der Differentialdiagnostik hirnorganischer Syndrome. Therapiewoche 1980; 30: 8080–8088.Google Scholar
  17. 17.
    Kollias SS, Golay X, Boesiger P and Valavanis A. Dynamic characteristics of oxygenation-sensitive MRI signal in different temporal protocols for imaging human brain activity. Neuroradiology 2000; 42: 591–601.PubMedCrossRefGoogle Scholar
  18. 18.
    Fristen KJ, Holmes AP, Worsley KJ, Poline J-B, Frith CD, and Frackowiak RSJ. Statistical parametric maps in functional imaging: a general linear approach. Hum Brain Mapp 1995; 2: 189–210.CrossRefGoogle Scholar
  19. 19.
    Tailarach J and Tournoux P. Co-planar Stereotaxic Atlas of the Human Brain. Stuttgart: Thieme, 1988.Google Scholar
  20. 20.
    Lockwood AH, Weissenborn K, Bokemeyer M, Tietge U and Burchert W. Correlations between cerebral glucose metabolism and neuropsychological test performance in nonalcoholic cirrhotics. Metab Brain Dis 2002; 17: 29–40.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2003

Authors and Affiliations

  • G. Kircheis
    • 1
  • O. Zafiris
    • 2
  • H-A. Rood
    • 3
  • F. Boers
    • 2
  • K. Zilles
    • 2
    • 4
  • D. Häussinger
    • 1
  1. 1.Department of Internal Medicine, Division of Gastroenterology, Hepatology and Infectious DiseasesHeinrich-Heine-University DüsseldorfDüsseldorf
  2. 2.Institute of Medicine, Research Center JülichDüsseldorf
  3. 3.Institute of Laser MedicineHeinrich-Heine-University DüsseldorfDüsseldorf
  4. 4.C. and O. Vogt Institute for Brain ResearchHeinrich-Heine-University DüsseldorfDüsseldorfGermany

Personalised recommendations