Peripheral Neuropathy in Liver Cirrhosis

Results

Symptoms attributable to neuropathy were present in five (15%) patients. They were generally mild and not disabling. Seven (21%) patients had clinical signs of peripheral neuropathy. Sensory impairment was present in four (12%) patients and motor weakness in two patients (6.1%). Tendon jerks (mostly the ankle jerks) were impaired or absent in five (15.1%) patients. Nerve conduction studies were abnormal in 24 (73%) patients.

Mean NS ± standard error of mean (SEM) was 2.4 ± 0.37. Nerve conduction abnormalities were analyzed in the group as a whole ( Table 2 ), and separately in alcohol-related and non-alcohol-related cirrhosis. There was a reduction of median motor conduction velocity in 63% and compound muscle action potential (CMAP) amplitude in 18% of cases. Ulnar motor conduction velocity was reduced in 58% and amplitude in 15% of patients. There was a decrease in common peroneal motor conduction velocity in 66% of patients and amplitude in 55% of patients. Median sensory conduction velocity was reduced in 63% of patients, sensory nerve action potential (SNAP) amplitude being decreased in 27% of patients. Ulnar sensory conduction velocity was decreased in 66% of patients with amplitude reduced in 30% of patients. Sural sensory amplitude was reduced in 52% of patients with conduction-velocity reduced in 57% of patients. F-wave latency from the median nerve was prolonged in 57% of patients. Only two patients had nerve-conduction velocities of less than 60% of lower limit of the normal range, suggesting severe demyelination.

The correlation of nerve-conduction abnormalities and NS with various factors was analyzed, including alcohol intake ( Table 3 ), severity of liver disease according to Child-Pugh class ( Table 4 ) and encephalopathy.

In patients with alcohol-related cirrhosis, the incidence of neuropathy was 88% and the mean NS was 3 ± 0.44, compared with a 56% incidence and mean NS of 1.7 ± 0.62 in non-alcohol-related cirrhosis. The incidence of neuropathy in Child's B- and Child's C-class cirrhosis was 71% and 75%, respectively, with mean NS being 2.3 ± 0.56 and 2.4 ± 0.59, respectively. The patients with encephalopathy and those without had an equal incidence of neuropathy (73%) and the mean NS was 2 ± 0.68 and 2.5 ± 0.48, respectively. Severity grading on the basis of NS revealed that 33% of the patients did not have any neuropathy, 64% had mild neuropathy, 3% had moderate neuropathy and none had severe neuropathy.

Cite this: Peripheral Neuropathy in Liver Cirrhosis - Medscape - Aug 01, 2003.

Table 1. Neuropathy score
Criteria	Score
Criteria	0	1	2	3
Clinical
Sensory symptoms	Normal	Limited to feet	Feet and hands	Disabling
Pin-prick or vibration sensation	Normal	Reduced up to wrist/ankle	Reduced up to elbow/knee	Reduced above elbow/knee
Motor power	Normal	Weakness at ankles	Weakness at ankle and hands	Generalized weakness
Tendon jerks	Normal	Ankle jerks reduced	Ankle jerks plus any other deep tendon jerks reduced	All reflexes absent
Nerve conduction
Peroneal motor amplitude	Normal or reduced by <5% of LLN	76-95% of LLN	51-75% of LLN	<50% of LLN
Median sensory amplitude	Normal or reduced by less than 5% of LLN	76-95% of LLN	51-75% of LLN	<50% of LLN

Table 2. Nerve-conduction study results
Nerve-conduction parameters	Abnormal (%)
No. of patients with abnormal study	73
Reduced conduction velocity
Median motor	63
Ulnar motor	58
Peroneal motor	66
Median sensory	63
Ulnar sensory	66
Sural sensory	57
Reduced amplitudes
Median motor CMAP	18
Ulnar motor CMAP	15
Peroneal motor CMAP	55
Median sensory SNAP	27
Ulnar sensory SNAP	30
Sural sensory SNAP	52
Prolonged median F-wave latency	57

Table 3. Relation of alcohol to nerve-conduction abnormalities and neuropathy score
Variable	Total patient no.	Patients with abnormal nerve conduction: n (%)	Neuropathy score (mean ± SEM)
Alcohol-related cirrhosis	17	15 (88^a)	3.0 ± 0.44^b
Non-alcohol-related cirrhosis	16	9 (56^a1)	1.7 ± 0.62^b1

Table 4. Relationship of Child-Pugh class to nerve-conduction abnormalities and neuropathy score
Variable	Total patient no.	Patients with abnormal nerve conduction: n (%)	Neuropathy score (mean ± SEM)
Child's B	17	12 (71^a)	2.3 ± 0.56^b
Child's C	16	12 (75^a1)	2.4 ± 0.59^b1

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

My Alerts

Add to Email Alerts

Peripheral Neuropathy in Liver Cirrhosis

Results

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

Email This

Feedback