J Mov Disord.  2016 Jan;9(1):28-34. 10.14802/jmd.15034.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community

• Methawasin K
• Chonmaitree P
• Wongjitrat C
• Rattanamongkolgul S
• Asawavichienjinda T

• KMID: 2308773
• DOI: http://doi.org/10.14802/jmd.15034

Abstract

OBJECTIVE
Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice.
METHODS
One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions.
RESULTS
Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38-29.71 and p < 0.001, OR = 13.65, 95% CI 4.71-39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients.
CONCLUSIONS
Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Keyword

Movement disorders; Hepatic cirrhosis; Intention tremor; Alcoholic cirrhosis; Hepatic encephalopathy

MeSH Terms

Alcoholism
Brain
Diagnosis
Dyskinesias
Fibrosis
Gastroenterology
General Practice
Hepatic Encephalopathy
Hepatolenticular Degeneration
Humans
Hypokinesia
Internal Medicine
Liver
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Movement Disorders*
Neurologic Examination
Odds Ratio
Parkinsonian Disorders
Portasystemic Shunt, Surgical
Prevalence*
Risk Factors*
Schools, Medical*
Tremor