Sunday, October 14, 2012

High Incidence of Parkinsonism in Patients With Liver Cirrhosis: Presented at ANA

High Incidence of Parkinsonism in Patients With Liver Cirrhosis: Presented at ANABy Brian Hoyle

BOSTON -- October 12 -- A high incidence of parkinsonism has been revealed in patients with liver cirrhosis, according to a study presented here at the 137th Annual Meeting of the American Neurological Association (ANA).

Available follow-up data suggest that the severity of Parkinson's disease improves after liver transplantation.

Cirrhosis-related parkinsonism represents a unique subset of acquired hepatocerebral degeneration, explained Diana Apetauerova, MD, Lahey Clinic, Burlington, Massachusetts, on October 9. The prevalence of this disorder and the natural history after replacement of the cirrhotic liver are currently unclear.

Dr. Apetauerova and colleagues are conducting an ongoing prospective study of 120 patients with liver cirrhosis to analyse parkinsonism prevalence in patients with liver cirrhosis and to explore the correlations between cirrhosis severity, parkinsonism, and neuroradiological and biological findings.

Each patient in this study underwent Unified Parkinson's Disease Rating Scale (UPDRS) testing and standard liver assessments before transplantation and at 6 weeks, 3 months, and 12 months after transplant surgery. Patients identified with parkinsonism also underwent brain magnetic resonance imaging (MRI). Correlation evaluations included model for end-stage liver disease (MELD) score; motor and total UPDRS scores; serum liver levels of copper, ammonia, manganese, and iron; and signal MRI changes.

The 62 patients with parkinsonism (52%) had a mean age of 55.5 years (range, 38-68 years); 37 were men. The 58 nonparkinsonism patients had a mean age of 54.2 years (range, 20-69 years); 46 were men. The 2 groups were also similar in the proportions of cirrhosis resulting from multiple diagnoses, alcohol, viral hepatitis, and other causes.

No correlation was evident between MELD severity and cirrhosis (mean MELD = 14.4 and 14.0 in parkinsonism and nonparkinsonism groups, respectively) and total motor UPDRS and cirrhosis (28.6 and 10 U, respectively; P =.71). No correlations were found between the 2 patient groups concerning copper (P =.36), ammonia (P =.86), manganese (P =.90), and iron (P =.30) levels. Mean manganese levels were similar between the parkinsonism and the nonparkinsonism groups (18.55 vs 16.98 mmol/L; P =.39). Mean iron levels were higher in the former group of patients (118.4 vs 103.2 mmol/L; P =.10).

Of the parkinsonism patients, 19 have undergone liver transplantation. Clinical improvement was noted at 6 weeks in bradykinesia, gait, and total UPDRS, but the change was not statistically significant. Improvement was significant by 3 months, however, in bradykinesia (P =.02), gait (P =.001), and total UPDRS (P =.03). Tremor and rigidity were improved, but not with statistical significance.

At 1 year after transplantation, examination of 16 of the patients revealed further clinical improvement in bradykinesia (P =.001), gait (P =.005), and total UPDRS (P =.002). Tremor and rigidity also were improved at that time.

Basal ganglia hyperintensity was apparent on all pretransplant MRIs. In 14 patients, the hyperintensity was resolved by 1 year after transplant. Increased pituitary T1 signal was seen in 59% of the parkinsonism patients before transplant but only 7% of nonparkinsonism patients. All pituitary signals were resolved after transplantation.

Funding for the study was provided by a Robert E. Wise Foundation Grant.

[Presentation title: Chronic Parkinsonism Associated With Liver Cirrhosis. Abstract T1707]


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