Spectral electroencephalogram in liver cirrhosis with minimal hepatic encephalopathy before and after lactulose therapy

Background and Aim:Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy. Spectral electroencephalogram (sEEG) analysis improves the recognition of MHE by decreasing inter-operator variability and providing quantitative parameters of brain dysfunction. We compared sEEG in patients with cirrhosis with and without MHE and the effects of lactulose on sEEG in patients with MHE. Methods:One hundred patients with cirrhosis (50 with and 50 without MHE) were enrolled. Diagnosis of MHE was based on psychometric hepatic encephalopathy score (PHES) of -5. Critical flicker frequency, model of end-stage liver disease score, and sEEG were performed at baseline in all patients. The spectral variables considered were the mean dominant frequency (MDF) and relative power in beta, alpha, theta, and delta bands. Patients with MHE were given 3months of lactulose, and all parameters were repeated. Results:Spectral electroencephalogram analysis showed lower MDF (7.81.7 vs 8.7 +/- 1.3Hz, P<0.05) and higher theta relative power (34.29 +/- 4.8 vs 24 +/- 6.7%, P=001) while lower alpha relative power (28.6 +/- 4.0 vs 33.5 +/- 5.3%, P=.001) in patients with MHE than in patients without MHE. With theta relative power, sensitivity 96%, specificity 84%, and accuracy of 90% were obtained for diagnosis of MHE. After lactulose treatment, MHE improved in 21 patients, and significant changes were seen in MDF (7.8 +/- 0.5 vs 8.5 +/- 0.6), theta (34.2 +/- 4.8 vs 23.3 +/- 4.1%), alpha (28.6 +/- 4.0 vs 35.5 +/- 4.5%), and delta relative power (13.7 +/- 3.5 vs 17.0 +/- 3.3%) after treatment (P0.05). Conclusions:Spectral EEG is a useful objective and quantitative tool for diagnosis and to assess the response to treatment in patients with cirrhosis with MHE.