Minimal hepatic encephalopathy

Abstract

Minimal hepatic encephalopathy (MHE) is a condition in which patients with cirrhosis of liver that has normal mental and neurological status on standard clinical examination exhibit a number of neuropsychiatric and neurophysiological defects. Its prevalence varies up to 80% in cirrhotics .It is characterized by a specific, complex cognitive dysfunction which is independent of sleep dysfunction or problems with overall intelligence. Increasing evidence indicates that MHE is an important disorder that may seriously impair a patients daily functioning and quality of life. Psychomotor slowing, visuoconstructive disabilities, attention deficits are among the few key features while fine motor performance is also impaired. MHE may predict the development of overt hepatic encephalopathy. Various tools have been evaluated for the correct diagnosis of MHE, however, in the absence of a "gold standard", combination of test methods is recommended to most reliably diagnosed MHE. Presently, lactulose is the mainstay of treatment for MHE. However various therapies like probiotics and ornithine aspartate are under evaluation as an alternative to lactulose.