Clinical and electrophysiological studies of peripheral nerve function in patients with chronic liver disease.

Abstract

1. A series of 24 (eight alcoholic, 16 non-alcoholic) patients with histologically confirmed cirrhosis of the liver was examined for clinical and electrodiagnostic evidence of peripheral nerve damage. 2. Clinical evidence of mild, asymptomatic peripheral neuropathy was found in only three (19%) of the non-alcoholic group. 3. Electrodiagnostic tests on the median, ulnar, lateral popliteal and sural nerves were undertaken for each patient. Abnormalities of distal motor latency, motor conduction velocity or sensory action potential amplitudes were noted in 17 (71%). Exclusion of three patients in whom abnormality was confined to the median nerve, with the possibility of carpal tunnel compression, gave a final overall figure of 14 (58%). In the non-alcoholic group there were ten (63%) with abnormalities. 4. Sensory action potential amplitudes were reduced in 16 (67%), but only eight (33%) had abnormal distal motor latencies or motor conduction velocities. Nerves were affected in a patchy and unpredictable manner. 5. The number of abnormal electrodiagnostic tests for each patient bore no direct relation to the length of history, nor to the severity of liver damage. 6. In a selected group of patients with no other demonstrable cause of peripheral nerve damage, there was a positive correlation between the number of abnormal electrodiagnostic tests and the degree of slowing of the EEG mean dominant frequency. Possible implications of this finding are discussed.