Thursday, April 26, 2012

EASL-Abnormal EEG activity in patients with Chronic Hepatitis C (HCV) infection and minimal liver disease

CNS-Central nervous system

Abnormal EEG activity in patients with Chronic Hepatitis C (HCV) infection and minimal liver disease
Speaker: Marsha Morgan
Author: E. Williams1, M. Herren2, C.D. Jackson3, H. Pflugrad2, J. Krause2, L.M. Weber2, K. Weissenborn2, M.Y. Morgan1*
Affiliation: 1Centre for Hepatology, Royal Free Campus, UCL Medical School, London, UK, 2Department of Neurology, Medizinische Hochschule, Hannover, Germany, 3Department of Neurophysiology, Royal Free Hospital; Royal Free NHS Trust, London, UK. *             

Background and aim:
Individuals with chronic HCV infection are frequently fatigued and have significant psychomotor difficulties even in the absence of significant liver injury. The objectivity of these findings has been questioned as these individuals also report high levels of anxiety and depression. The aim of this study was to determine whether EEG analysis could provide objective evidence of CNS involvement in HCV infection.

The study population comprised 114 HCV-infected individuals (75 women: 39 men; mean [range] age 52.0 [25-75] years) with little or no liver disease; the majority had been infected by contaminated blood or blood products; none was misusing alcohol nor on treatment with interferon or psychoactive medication at the time of the study. All patients underwent formal assessment of fatigue, depression and anxiety and extensive psychometric testing. EEGs were recorded on the same day as the neuropsychometric assessment; reference data were obtained from 137 age/gender-matched healthy controls. The EEG was defined as 'fast' if the relative β power was >30% on the P3-P4 derivation.

 The prevalence of fast EEG activity was significantly greater in the patients than controls 43% vs. 15% (p< 0.0001). Significant correlations were observed between the presence of fast EEG activity and impairments in specific psychometric tests but not with fatigue, depression or anxiety.

These abnormalities were observed independently of HCV-RNA levels and treatment status (Table)

RNA negative (n = 9)RNA positive (n = 55)RNA negative (n = 11)RNA positive (n = 39)
Fast EEG33423649

 Patients with HCV infection with little or no liver injury show impaired cognitive function and an excess of fast EEG activity independent of fatigue, depression and anxiety. These findings hold true even if the patients have cleared the virus, either spontaneously or following anti-viral treatment. These results could be indicative of an effect of cerebral HCV-quasispecies similar to that suggested in HIV-associated dementia.

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