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Disruption of smooth pursuit eye movements in cirrhosis: relationship to hepatic encephalopathy and its treatment.

Montagnese, S; Gordon, HM; Jackson, C; Smith, J; Tognella, P; Jethwa, N; Sherratt, RM; (2005) Disruption of smooth pursuit eye movements in cirrhosis: relationship to hepatic encephalopathy and its treatment. Hepatology , 42 (4) pp. 772-781. 10.1002/hep.20855. Green open access

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Abstract

Smooth pursuit eye movements (SPEM) are the conjugate movements used to track the smooth trajectory of small dots. Jerky or 'saccadic' ocular pursuit has been reported in patients with cirrhosis, but no formal assessment of SPEM has ever been undertaken. The aim of this study was to evaluate SPEM in patients with cirrhosis and varying degrees of hepatic encephalopathy. The patient population comprised 56 individuals (31 men, 25 women) of mean age 51.1 (range, 25-70) years, with biopsy-proven cirrhosis, classified, using clinical, electroencephalographic, and psychometric variables, as either neuropsychiatrically unimpaired or as having minimal or overt hepatic encephalopathy; patients were further categorized in relation to their treatment status. The reference population comprised 28 healthy volunteers (12 men, 16 women) of mean age 47.3 (range, 26-65) years. SPEM was assessed using an electro-oculographic technique. Visual inspection of the SPEM recordings showed clear disruption of smooth pursuit in the patients with minimal hepatic encephalopathy, and more pronounced disruption, if not complete loss, of smooth pursuit in patients with overt hepatic encephalopathy. The differences observed in quantifiable SPEM indices between the healthy volunteers/unimpaired patients and those with overt hepatic encephalopathy were significant (P < .05). In conclusion, SPEM performance is impaired in patients with hepatic encephalopathy in parallel with the degree of neuropsychiatric disturbance: the pathophysiology of these changes is unknown, but retinal, extrapyramidal, and attentional abnormalities are likely to play a role. Treatment status confounds the classification of neuropsychiatric status and should be taken into account when categorizing these patients.

Type: Article
Title: Disruption of smooth pursuit eye movements in cirrhosis: relationship to hepatic encephalopathy and its treatment.
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/hep.20855
Keywords: Adult, Aged, Attention, Cognition Disorders, Female, Hepatic Encephalopathy, Humans, Liver Cirrhosis, Liver Cirrhosis, Alcoholic, Male, Middle Aged, Ocular Motility Disorders, Pursuit, Smooth, Severity of Illness Index
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/815
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