Year 2022 / Volume 114 / Number 2
Original
Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy

83-88

DOI: 10.17235/reed.2021.7709/2020

Ángel Daniel Santana-Vargas, Fátima Higuera-De la Tijera, José Luis Pérez-Hernández,

Abstract
Introduction: the diagnosis of minimal hepatic encephalopathy (MHE) requires psychometric tests, although new methods are needed since their sensitivity, specificity, and accuracy are low. The P300 event-related potential (ERP) is obtained by auditory and visual stimuli, although only the auditory P300 has been used to detect MHE. This study aimed to compare the diagnostic features of auditory and visual P300 to detect MHE. Materials and methods: sixty patients with liver cirrhosis and thirty-five healthy controls completed the Psychometric Hepatic Encephalopathy Score (PHES), the critical flicker frequency (CFF), and auditory and visual P300 tests. MHE was diagnosed if PHES and CFF scores were abnormal. Results: fifty-three cirrhotic patients (aged 54.5 ± 8.6 years) completed all tests. Abnormal scores were obtained for PHES (49.1 %) and CFF (67.9 %). The proportion of MHE was 21.4 %. The area under the receiver operating (ROC) curves (AUROC) for auditory P300 was better than for visual P300 for distinguishing MHE from controls (AUROC: 0.792 vs 0.725; p < 0.005 for both; accuracy: 73.8 % vs 70.2 %; sensitivity: 72.2 % for both; specificity: 74.2 vs 69.7, respectively). Among cirrhotic patients, only auditory P300 was useful to detect MHE (AUROC: 0.723; p < 0.05; 77.4 % accuracy; 61.1 % sensitivity, and 81.8 % specificity). Conclusions: auditory P300 sensitivity, specificity, and accuracy were similar to those of CFF. Our results showed that only auditory P300 is useful to differentiate patients with MHE, although both modalities, auditory and visual, differentiated patients with cirrhosis from controls. Thus, we consider that visual P300 is not suitable for detecting MHE.
Share Button
New comment
Comments
No comments for this article
References
Weissenborn K. Diagnosis of minimal hepatic encephalopathy. J Clin Exp Hepatol 2015;5(Suppl 1):S54-9. DOI: 10.1016/j.jceh.2014.06.005
2. Barone M. Neurophysiologic and psychometric tests in the diagnosis of low-grade encephalopathy. Gastroenterology 2015;148(3):663.
3. Bianchi G, Giovagnoli M. Hepatic Encephalopathy and Health-Related Quality of Life. Clin Liver Dis 2012;16(1):159-70.
4. Kircheis G, Knoche A, Hilger N, et al. Hepatic Encephalopathy and Fitness to Drive. Gastroenterology 2009;137(5):1706-15.e1-9. DOI: 10.1053/j.gastro.2009.08.003
5. Dhiman RK, Chawla YK. Minimal hepatic encephalopathy. Indian J Gastroenterol 2009;28(1):5-16. DOI: 10.1007/s12664-009-0003-6
6. Kircheis G, Hilger N, Häussinger D. Value of critical flicker frequency and psychometric hepatic encephalopathy score in diagnosis of low-grade hepatic encephalopathy. Gastroenterology 2014;146(4):961-9. DOI: 10.1053/j.gastro.2013.12.026
7. Dhiman RK, Saraswat VA, Sharma BK, et al. Minimal hepatic encephalopathy: Consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol 2010;25(6):1029-41.
8. Nabi E, Bajaj JS. Useful tests for hepatic encephalopathy in clinical practice. Curr Gastroenterol Rep 2014;16(1):1-14.
9. Nardone R, Taylor AC, Höller Y, et al. Minimal hepatic encephalopathy: A review. Neurosci Res 2016;111:1-12.
10. Torlot FJ, McPhail MJW, Taylor-Robinson SD. Meta-analysis: The diagnostic accuracy of critical flicker frequency in minimal hepatic encephalopathy. Aliment Pharmacol Ther 2013;37(5):527-36.
11. Kappus MR, Bajaj JS. Assessment of Minimal Hepatic Encephalopathy (with Emphasis on Computerized Psychometric Tests). Clin Liver Dis 2012;16(1):43-55.
12. Amodio P, Valenti P, Del Piccolo F, et al. P300 latency for the diagnosis of minimal hepatic encephalopathy: Evidence that spectral EEG analysis and psychometric tests are enough. Dig Liver Dis 2005;37(11):861-8.
13. Saxena N, Bhatia M, Yk J, et al. Electrophysiological and neuropsychological tests for the diagnosis of subclinical hepatic encephalopathy and prediction of overt encephalopathy. Liver 2002;22(3):190-7.
14. Sharma P, Sharma BC, Puri V, et al. An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 2008;20(6):506-11.
15. Polich J. Neuropsychology of P300. Oxford Handbooks Online; 2012. p. 1-53.
16. Polich J, Alexander JE, Bauer LO, et al. P300 Topography of Amplitude/Latency Correlations. Brain Topogr 1997;9(4):275-82. DOI: 10.1007/BF01464482
17. Saxena N, Bhatia M, Joshi YK, et al. Liver cirrhosis: bacterial peritonitis, pleural effusion and encephalopathy: Auditory p300 event-related ptoentials and number connection test for evaluation of subclinical hepatic encephalopathy in patients with cirrhosis of the liver: a follow up study. J Gastroenterol Hepatol 2001;16(3):322-7. DOI: 10.1046/j.1440-1746.2001.02388.x
18. Jin-Hwa M, Dae Won J, Myung-Kul Y, et al. Prolonged N200 is the early neurophysiologic change in the patient with minimal hepatic encephalopathy. Scand J Gastroenterol 2014;49(5):604-10. DOI: 10.3109/00365521.2013.878382
19. Dreo J, Attia D, Sek ZP. The P3 cognitive ERP has at least some sensory modality-specific generators: Evidence from high-resolution EEG. Psychophysiology 2017;54(3):416-28. DOI: 10.1111/psyp.12800
20. Duncan CC, Barry RJ, Connolly JF, et al. Clinical Neurophysiology Event-related potentials in clinical research : Guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400 q. Clin Neurophysiol 2009;120(11):1883-908.
21. Duarte-Rojo A, Estradas J, Hernández-Ramos R, et al. Validation of the psychometric hepatic encephalopathy score (PHES) for identifying patients with minimal hepatic encephalopathy. Dig Dis Sci 2011;56(10):3014-23.
22. Sharma P, Sharma BC. Predictors of Minimal Hepatic Encephalopathy in Patients with Cirrhosis. Saudi J Gastroenterol 2010;16(3):181-7. DOI: 10.4103/1319-3767.65189
23. Sharma BC, Sharma P, Sarin SK. Predictors of nonresponse to lactulose for minimal hepatic encephalopathy in patients with cirrhosis. Liver Int 2009;29(9):1365-71.
24. Sharma K, Pant S, Misra S, et al. Effect of rifaximin, probiotics, and l-ornithine l-aspartate on minimal hepatic encephalopathy: A randomized controlled trial. Saudi J Gastroenterol [Internet] 2014;20(4):225.
25. Esmat S, Garem N El, Raslan H, et al. Critical flicker frequency is diagnostic of minimal hepatic encephalopathy. J Investig Med 2017; 65(8):1131-5. DOI: 10.1136/jim-2017-000428
26. Sharma P, Sharma BC, Sarin SK. Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis. Hepatobiliary Pancreat Dis Int 2010;9(1):27-32.
27. Mittal VV, Sharma BC, Sharma P, et al. A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L-aspartate in treatment of minimal hepatic encephalopathy. Eur J Gastroenterol Hepatol 2011;23(8):725-32.
Related articles
Citation tools
Santana-Vargas Á, Higuera-De la Tijera F, Pérez-Hernández J. Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy. 7709/2020


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 393 visits.
This article has been downloaded 97 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 07/12/2020

Accepted: 23/01/2021

Online First: 10/02/2021

Published: 07/02/2022

Article revision time: 38 days

Article Online First time: 65 days

Article editing time: 427 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology