PERIPHERAL NEUROPATHIES AND CHRONIC HEPATITIS C

Abstract

Objectives: Recent interest has been expressed in peripheral neuropathies in hepatitis C virus (HCV) patients. The aim of this prospective study was to evaluate the prevalence of peripheral neuropathies associated with chronic hepatitis and their clinical manifestations.Patients and method: Ninety anti‐HCV‐positive patients were consecutively interviewed and examined by the same operator. Forty‐five patients with end‐stage liver disease and awaiting liver transplantation were evaluated at the Liver Transplantation Center (Group 1). Further 45 patients were referred for neurological consultation during hospitalisation in the Department of Medicine (Group 2), where they had been admitted for different clinical reasons. One patient from group 1 and 5 patients from group 2 were excluded from the study because of previous neurological diseases. All patients underwent a standardized neurological evaluation, including history, neurological examination, mini mental state examination, neuropathy symptom score, and neurological disability score. In presence of symptoms and signs of peripheral neuropathy, an electrophysiological evaluation was performed.Results: Signs or history of encephalopathy were found in 23/44 patients of group 1 (52.2%) and in 8/40 patients of group 2 (20%). Clinical manifestations of neuropathy, confirmed by electrophysiological examination, were found in 11 subjects of group 1 (25%) and in 17 patients of group 2 (42.5%). Most patients had minor symptoms; sensory disturbances occurred more frequently than motor and autonomic dysfunctions. In group 1, peripheral neuropathy was associated with systemic illness (diabetes, renal failure, liver neoplasm, previous alcohol abuse) in 4/11 patients (36.3%); conversely, in all patients from group 2, other possible etiological factors were present: alcohol abuse in 3; diabetes in 4; renal failure in 1; mixed cryoglobulinemia in 7; and neoplasm in 2.Conclusions: Symptomatic but not disabling neuropathies were found in 33% of HCV in patients. Sensory involvement was prevalent. Systemic illness and mixed cryoglobulinemia were more frequently present in Group 2 than in Group 1. This finding suggests that the metabolic dysfunctions caused by liver disease may be the primary determinant of peripheral system damage only in patients with end‐stage liver disease.