Thirty-three patients with liver cirrhosis presenting to the department of Hepatology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, were evaluated for the presence of neuro-pathy. A diagnosis of cirrhosis was made on the basis of clinical, biochemical, ultrasound and endoscopic evidence and, wherever possible, by liver biopsy when prothrombin time permitted it to be performed. It was considered alcohol-related if the patient had consumed more than 80 g of alcohol per day for more than 10 years. Seventeen patients had alcohol-related cirrhosis and 16 patients (five hepatitis B virus, four hepatitis C virus, seven cryptogenic) had non-alcohol-related cirrhosis. The severity of liver cirrhosis was graded using the Child-Pugh classification. Seventeen cases were in class B, 16 in class C and none in class A. There were 26 male and seven female patients. Eleven patients had histories of encephalopathy and 17 of gastrointestinal bleeding.
Patients having an identifiable cause of peripheral neuropathy, except alcohol, were excluded from the study that included patients with diabetes. Patients with evidence of vitamin B12 deficiency were also excluded from the study. All patients underwent a standardized neurological evaluation, including a history and clinical examination. Nerve conduction study was conducted on a Nicolet Viking IV EMG/EP system (Nicolet Biomedical, Madison, WI, USA). Informed consent was obtained for all patients. The nerves studied included median and ulnar (motor and sensory), common peroneal (motor) and sural sensory. F-waves were recorded from the median nerve. The results were analyzed by comparing the values with an equal number of age- and sex-matched normal controls. Values beyond 'two standard deviations' from normal were taken as abnormal. 'Neuropathy' was defined by the presence of two or more abnormalities on electrophysiological testing of the above-mentioned nerves with regards to distal latency, conduction velocity, amplitude of action potentials and F-wave latency. The severity of neuropathy and its grading was assessed by a 'neuropathy score' (NS) ( Table 1 ), modified from the 'total neuropathy score' used by Chaudhryet al.[18,19]
The results obtained were analyzed for statistical significance using X 2 test for qualitative comparison and unpaired t-test for quantitative comparison.
The protocol for this research project was approved by the Ethics Committee of the Institute.
J Gastroenterol Hepatol. 2003;18(8) © 2003 Blackwell Publishing
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