Title:A Study of Extrapyramidal Manifestations Accompanying Decompensated Viral Hepatic Cirrhosis Patients
Volume: 12
Issue: 3
Author(s): Samia Ashour, Ahmed Gaber, Osama Aboelfotoh Aly, Saeed Hashem, Mohamed M. Salama and Ali S. Shalash*
Affiliation:
- Department of Neurology, Faculty of medicine, Ain Shams University, Cairo, 11566,Egypt
Keywords:
Chronic liver disease, extrapyramidal, hepatic encephalopathy, parkinsonism, UPDRS-III scale, viral.
Abstract: Background: Despite the high prevalence of viral hepatic cirrhosis all over the world, the
characteristic motor features of related Parkinsonism (extrapyramidal manifestations) are not well described.
The current study aimed to characterize such disorder in a sample of Egyptian patients with
chronic viral liver disease (CLD), and their clinical correlates.
Methods: Ninety-six (96) patients with CLD were examined for the presence of extrapyramidal signs.
Parkinsonism was assessed using the UPDRS-III scale and its sub scores. Ataxia and dystonia were
also assessed by related scales. Patients with Parkinsonism were compared to other patients and correlations
with clinical features of CLD were done.
Results: The clinical diagnosis of extrapyramidal manifestations was justified in 57 patients (59.4%)
with predominant akinetic rigid syndrome (ARS) (87.7%). Bradykinesia and axial features were the
most frequent signs (89.5% and 70.2%, respectively). 38.6% of patients had postural tremors, whereas
only 3.5% had rest tremors. Gait and postural abnormalities were detected in 38.6% and 36.8% respectively.
Parkinsonism was associated with advanced hepatic cirrhosis (p=0.02) and increased episodes
of hepatic encephalopathy (HE) (p=0.006). Severity of parkinsonian features was correlated to
patients' age, age of onset of CLD and rapid progression, while impaired speech and gait were rather
correlated to a number of episodes of HE.
Conclusion: Advanced viral cirrhosis is associated with high prevalence of parkinsonism that is characterized
by symmetrical ARS with frequent axial features, postural tremor, gait and postural impairment.
Severity of these signs is correlated to age, age of onset, rapid progression and frequency of HE.
