Relation between the severity of liver cirrhosis and neurological symptoms, nerve conduction study results, and motor unit number estimation.

Abstract

Liver cirrhosis is a global health problem that can be associated with several neurological manifestations. We aimed to assessment of the relation between the severity of the liver cirrhosis and the neurological symptoms, nerve conduction studies (NCS), as well as detecting subclinical neuropathic affection using motor unit number estimation (MUNE) technique. This cross-sectional study was conducted on 56 cirrhotic patients and 61 age- and sex-matched healthy controls. Neurological manifestations, Child-Pugh classification, Model for End-Stage Liver Disease score, NCS and MUNE using a modified spike-triggered averaging technique were studied. Forty-five (80.3%) of the cirrhotic patients had neurological manifestations. Muscle cramps were the most frequently reported manifestation, followed by fatigue and then numbness. NCS abnormality was significantly related to the presence of neurological symptoms (p<0.001) and not only to peripheral numbness. Only fatigue was significantly related to the lower MUNE values (p<0.017). Child-Pugh classification progression was significantly related to the presence of fatigue and abnormal NCS results (p<0.001); no similar relation was detected between the Child-Pugh classification and the MUNE value (p=0.103). Higher MELD scores were significantly related to NCS abnormalities (p=0.014) and negatively correlated, although not significantly, with the MUNE values (r=-0.246 and p=0.067). The progression of liver cirrhosis was related to the presence of neurological manifestations and nerve conduction abnormalities. Nerve conduction abnormalities may be present even in the absence of clinical numbness. A decline in motor unit number could explain the pathophysiology of fatigue in cirrhotic patients.