Characterization and evaluation of alterations in sensitivity and autonomic function in cirrhotic patients with minimal hepatic encephalopathy

Résumé

Cirrhotic patients may experience alterations in the peripheral nervous system and in somatosensory perception. Impairment of the somatosensory system could contribute to cognitive and motor alterations characteristic of minimal hepatic encephalopathy (MHE), which affects up to 40% of cirrhotic patients. We assessed the relationship between MHE and alterations in thermal, vibration, and/or Heat Pain sensitivity in 58 cirrhotic patients (38 without and 20 with MHE according to Psychometric Hepatic Encephalopathy Score) and 39 controls. All participants underwent attention and coordination tests, a nerve conduction study, autonomic function testing, and evaluation of sensory thresholds (vibration, cooling, and Heat Pain detection) by electromyography and quantitative sensory testing. The detection thresholds for cold and Heat Pain on the foot were higher in patients with MHE than those without MHE. This hyposensitivity correlated with attention deficits. Reaction times in the foot were longer in patients with MHE than without MHE. Patients with normal sural nerve amplitude showed altered thermal sensitivity and autonomic function, with stronger alterations in patients with MHE than in those without MHE. MHE patients show a general decrease in cognitive and sensory abilities. Small fibres of the autonomic nervous system and thermal sensitivity are altered early on in MHE, before large sensory fibres. Quantitative sensory testing could be used as a marker of MHE.