Relation Between the Severity of Liver Cirrhosis and Neurological Symptoms, Nerve Conduction Study Results, and Motor Unit Number Estimation

Reem M Gabr; Dina A El Salmawy; Mye A Basheer; Marwa khairy; Saly H Elkholy


J Viral Hepat. 2021;28(9):1312-1318. 

In This Article


The baseline characteristics of the studied cirrhotic patients (Group 1) are presented in Table 1. The cirrhotic patients had a mean age of 50.55 + 9.44 years old, and 73.2% were males. Their mean body mass index was 28.32 + 5.03 kg/m2, 5.38% were known cardiac patients, and 80.4% were nonsmokers. All had within normal serum Na, K and calcium levels, urea, and creatinine levels. All had no definite abnormalities in abdominal ultrasound apart from cirrhotic liver.

HCV-related liver cirrhosis was the most common aetiology for cirrhosis, accounting for 80.3% of the patients. Regarding the Child-Pugh classification, 62.5% of the patients were class A (ie compensated), 30.4% were class B, and 7.1% were class C. The mean MELD score was 7.32 ± 2.19 in all patients.

Concerning the clinical presentation, 45 (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently detected clinical presentation (36 patients), followed by fatigue (20 patients), and then numbness (14 patients). It is to be noted that only four of them who had motor power less than grade '3', among them only two experienced fatigue.

A statistically significant relation between the patient's complaint of fatigue and the progression of liver cirrhosis represented by Child-Pugh class (p <0.001) was observed. No similar significant relations were noted between numbness or muscle cramps and the Child-Pugh classification (Table 2).

As regards the NCSs results, they were considered abnormal in 16 patients (28.6%), whereas the NCSs results in the remaining 40 patients (71.4%) did not fulfil the criteria for diagnosis of peripheral neuropathy (Table 1). The pattern of peripheral neuropathy was of the axonal type.

There was a statistically significant relation between NCS abnormality and the presence of neurological symptoms (p < 0.001), which was not the case in cirrhotic patients without neurologic manifestations. Interestingly, the axonal neuropathy detected by the NCSs was not only related to the presence of peripheral numbness clinically but was also present with muscle cramps and fatigue. Of the 16 patients with abnormal NCS results, 10 patients (62.5%) had numbness, 11 patients (68.75%) had fatigue, and 11 patients (68.75%) had muscle cramps as shown in Figure 2.

Figure 2.

Neurological manifestations distribution in relation to nerve conduction abnormalities among the studied cirrhotic patients

Abnormal NCS results were significantly more frequent in the patients with Child-Pugh class B and C cirrhosis compared to the patients with class A cirrhosis (p < 0.001). Also, the patients with abnormal NCS findings showed significantly higher MELD score values than those with normal NCS findings (p = 0.014); however, no significant relation was detected between the NCS results and the MUNE value (p = 0.062; Table 3).

Reaching the MUNE results, their mean value in the patients with cirrhosis (39.30 ± 15.68) was significantly lower (p < 0.001) than the value in the healthy control group (47.79 ± 12.28).

In the studied cirrhotic patients, while searching for a relation between MUNE and neuropathic clinical symptoms, there was a significant relation between the presence of fatigue and lower MUNE values (p < 0.017), whereas no significant relation was noted between the presence of numbness or muscle cramps and MUNE values (Table 4).

Finally, when statistically processing the mean MUNE value and the progression of liver cirrhosis, no significant relation was detected between the Child-Pugh classification progression and the decreased MUNE value (p = 0.103). However, a negative correlation was noticed between the MELD score and the MUNE value that did not reach significance (r = −0.246 and p = 0.067).

The data that support the findings of this study are available from the corresponding author upon reasonable request.