Electroencephalogram variability in patients with cirrhosis associates with the presence and severity of hepatic encephalopathy

JOURNAL OF HEPATOLOGY

卷:65

Article

Olesen, Soren Schou¹  Gram, Mikkel¹  Jackson, Clive Douglas²  Halliday, Edwin³  Sandberg, Thomas Holm¹  Drewes, Asbjorn Mohr^1,4  Morgan, Marsha Yvonne³ 

[1] Aalborg Univ Hosp, Dept Gastroenterol & Hepatol, Mech Sense, Hobrovej 18-22, DK-9100 Aalborg, Denmark

[2] Royal Free London NHS Fdn Trust, Royal Free Hosp, Dept Neurophysiol, London, England

[3] UCL, Div Med, UCL Inst Liver & Digest Hlth, Royal Free Campus, London, England

[4] Aalborg Univ, Dept Clin Med, Aalborg, Denmark

关键词: Biological variability;    Cirrhosis;    Continuous wavelet transform;    Electroencephalogram;    Hepatic encephalopathy;    Sample entropy;    Spectral analysis;   

DOI  :  10.1016/j.jhep.2016.05.004

来源: Elsevier

【 摘 要 】

Background & Aims: The outputs of physiological systems fluctuate in a complex manner even under resting conditions. Decreased variability or increased regularity of these outputs is documented in several disease states. Changes are observed in the spatial and temporal configuration of the electroencephalogram (EEG) in patients with hepatic encephalopathy (HE), but there is no information on the variability of the EEG signal in this condition. The aim of this study was to measure and characterize EEG variability in patients with cirrhosis and to determine its relationship to neuropsychiatric status. Methods: Eyes-closed, awake EEGs were obtained from 226 patients with cirrhosis, classified, using clinical and psychometric criteria, as neuropsychiatrically unimpaired (n = 127) or as having minimal (n = 21) or overt (n = 78) HE, and from a reference population of 137 healthy controls. Analysis of EEG signal variability was undertaken using continuous wavelet transform and sample entropy. Results: EEG variability was reduced in the patients with cirrhosis compared with the reference population (coefficient of variation: 21.2% [19.3-23.4] vs. 22.4% [20.8-24.5]; p < 0.001). A significant association was observed between EEG variability and neuropsychiatric status; thus, variability was increased in the patients with minimal HE compared with their neuropsychiatrically unimpaired counterparts (sample entropy: 0.98 [0.87-1.14] vs. 0.83 [0.75-0.95]; p = 0.02), and compared with the patients with overt HE (sample entropy: 0.98 [0.87-1.14] vs. 0.82 [0.71-1.01]; p = 0.01). Conclusions: Variability of the EEG is associated with both the presence and severity of HE. This novel finding may provide new insights into the pathophysiology of HE and provide a means for monitoring patients over time. Lay summary: Decreased variability or increased regularity of physiological systems is documented in several disease states. Variability of the electroencephalogram was found to be associated with both the presence and severity of brain dysfunction in patients with chronic liver disease. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

Free