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.
J Gastroenterol Hepatol. 2003;18(8) © 2003 Blackwell Publishing
Cite this: Peripheral Neuropathy in Liver Cirrhosis - Medscape - Aug 01, 2003.