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Cerebellar inhibition in hepatic encephalopathy
Authors:Shady Safwat Hassan  Thomas J. Baumgarten  Anwar M. Ali  Nur-Deniz Füllenbach  Markus S. Jördens  Dieter Häussinger  Markus Butz  Alfons Schnitzler  Stefan Jun Groiss
Affiliation:1. Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany;2. Department of Neurology, Medical Faculty, Assiut University Hospital, Assiut, Egypt;3. Department of Gastroenterology, Hepatology and Infectiology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany;4. Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
Abstract:ObjectivePrevious animal work reported that hyperammonemia leads to opposing changes of GABAergic neurotransmission in terms of increase in the cerebellum and decrease in the cerebral cortex. In this study, we investigate GABAergic tone in the cerebellum in patients with hepatic encephalopathy (HE) at different stages of the disease and its relation to critical flicker frequency (CFF) and ataxia.MethodsCerebellar inhibition using transcranial magnetic stimulation was investigated in 15 patients with different stages of HE and 15 healthy controls. All patients were assessed using CFF and the score for assessment and rating of ataxia (SARA).ResultsDecreased cerebellar inhibition (CBI) was observed in manifest HE at interstimulus interval from 5 to 7 ms. However, the degree of CBI at 7 ms correlated significantly with disease severity measured with SARA and with CFF by trend.ConclusionReduced CBI in HE patients indicates affection of the cerebellar efferent pathway. The disease severity dependent increase of CBI magnitude supports the notion of disease stage dependent increase of GABAergic neurotransmission in Purkinje cells.SignificanceThe results support previous animal experiments showing increase of GABA-ergic neurotransmission in the cerebellum and decrease in the motor cortex in HE.
Keywords:Corresponding author at: Department of Neurology, Heinrich Heine University, Moorenstr 5, 40225 Düsseldorf, Germany. Fax: +49 211 81 015 08473.  Transcranial magnetic stimulation (TMS)  Cerebellar inhibition (CBI)  Hepatic encephalopathy (HE)  Gamma Aminobutyric Acid (GABA)  Critical flicker frequency (CFF)  Score for assessment and rating of ataxia (SARA)
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