Die hepatische Enzephalopathie (HE) ist eine metabolisch
induzierte, potenziell reversible Funktionsstörung des
Zentralnervensystems im Rahmen von Leberkrankheiten. Im weitesten
Sinne schließt sie alle neuropsychiatrischen Syndrome, die
bei akuten oder chronischen Lebererkrankungen auftreten können
und kausal durch die Leberfunktionsstörung bedingt sind,
ein. Die HE umfasst ein breites Spektrum unterschiedlicher klinischer
Zustandsbilder. Zahlreiche Synonyme geben meist nur Teilaspekte
wieder. Voraussetzung für die Diagnose einer HE ist der
Nachweis einer Lebererkrankung, der Nachweis einer Funktionsstörung
des zentralen Nervensystems und der sichere Ausschluss einer anderen
neurologischen Erkrankung. Während der Nachweis einer Lebererkrankung
bzw. die Diagnose der Funktionsstörung des zentralen Nervensystems
unproblematisch ist, kann die Abgrenzung zu anderen neurologischen
Erkrankungen, die bei Leberkrankheiten auftreten können,
schwierig sein.
Literatur
1
Amodio P, Marchetti P, Del Piccolo F. et al .
Visual attention in cirrhotic patients.
Hepatology.
1998;
27
1517-1523
2
Amodio P, Marchetti P, Del P iccolo F, de Tourtchaninoff M, Varghese P, Zuliani C. et al .
Spectral versus visual EEG analysis in
mild hepatic encephalopathy.
Clin Neurophysiol.
1999;
110
1334-1344
4
Barbaro G, Di
Lorenzo G, Soldini M. et
al .
Flumazenil for hepatic encephalopathy grade III
and IVa in patients with cirrhosis.
Hepatology.
1998;
28
374-378
5
Basile A S, Pandl L, Jaouni T. et al .
Brain concentrations of benzodiazepines
are elevated in an animal model of hepatic encephalopathy.
Proc Natl
Acad Sci USA.
1990;
87
5263-5267
6
Basile A S, Harrison P M, Hughes R D. et al. .
Relationship between plasma benzodiazepine
receptor ligand concentrations and severity of hepatic encephalopathy.
Hepatology.
1994;
19
112-121
7
Bucci L, Palmieri G C.
Double-blind,
double-dummy comparison between treatment with rifaximin and lactulose
in patients with medium to severe degree hepatic encephalopathy.
Curr-Med
Res Opin.
1993;
13
109-118
9
Cadranel J F, el Younsi M, Pidoux B, Zylberberg P, Benhamou Y, Valla D, Opolon P.
Flumazenil
therapy for hepatic encephalopathy in cirrhotic patients.
Eur
J Gastroenterol Hepatol.
1995;
7
325-329
10
Chan H, Hazell A S, Desjardins P, Butterworth R F.
Effects
of ammonia on glutamate transporter (GLAST) protein and mRNA in
cultured rat cortical astrocytes.
Neurochem Int.
2000;
37
243-248
11
Conn H O, Leevy C M, Vlahcevic Z R, Rodgers J B, Maddrey W C, Seeff L, Levy L L.
Comparison
of Lactulose and Neomycin in the Treatment of Chronic Portal-systemic
Encephalopathy.
Gastroenterology.
1977;
72
573-583
12
Desjardins P, Rao K V, Michalak A, Rose C, Butterworth R F.
Effect
of portacaval anastomosis on glutamine synthetase protein and gene
expression in brain, liver and skeletal muscle.
Metab
Brain Dis.
1999;
14
273-280
13
Egberts E H, Schomerus H, Hamster W, Jürgens P.
Branched Chain
Amino Acids in the Treatment of Latent Portosystemic Encephalopathy.
Gastroenterology.
1985;
88
887-895
14
Efrati C, Masini A, Merli M, Valeriano V, Riggio O.
Effect of sodium benzoate on
blood ammonia response to oral glutamine challenge in cirrhotic
patients: a note of caution.
Am J Gastroenterol.
2000;
95
3574-3578
15 Ferenci P. Diagnosis
and differential diagnosis of hepatic encephalopathy: Implications
for the design of clinical studies. Univ. of Newcastle upon
Tyne In: Advances in Hepatic encephalopathy and
metabolism in liver diseases. CO Record, H Al Mardini (eds) 1997: 267-272
18
Grippon P, Le Poncin-Laffite M, Boschat M. et al .
Evidence for the role of ammonia in the
intracerebral transfer and metabolism of tryptophan.
Hepatology.
1986;
6
682-6686
19
Groeneweg M, Gyr K, Amrein R, Scollo-Lavizzari G, Williams R, Yoo J Y, Schalm S W.
Effect of flumazenil
on the electroencephalogram of patients with portosystemic encephalopathy.
Results of a double blind, randomized, placebo-controlled multicenter
trial.
Electroencephalogr Clin Neurophysiol.
1996;
98
29-34
20
Horst D, Grace N D, Conn H O. et al .
Comparison
of dietary protein with an oral, branched chain-enriched amino acid
supplement in chronic portal-systemic encephalopathy.
Hepatology.
1984;
4
279-287
21
Hartmann I J, Groeneweg M, Quero J C, Beijeman S J, de Man R A, Hop W C, Schalm S W.
The
prognostic significance of subclinical hepatic encephalopathy.
Am
J Gastroenterol.
2000;
95
2029-2034
23
Kircheis G, Nilius R, Held C. et
al .
Therapeutic efficacy of L-ornithine-L-aspartate
infusions in patients with cirrhosis and hepatic encephalopathy:
results of a placebo-controlled, double blind study.
Hepatology.
1997;
25
1351-1360
24
Kramer L, Tribl B, Gendo A, Zauner C, Schneider B, Ferenci P, Madl C.
Comparison
of ammonia partial pressure and total ammonia in hepatic encephalopathy.
Hepatology.
2000;
31
30-34
27
Loguercio C, Abbiati R, Rinaldi M, Romano A, del Vecchio
Blanco C, Coltori M.
Long-term
effects of enterococcus faecium SF68 versus lactulose in the treatment
of patients with cirrhosis and grade 1 - 2
hepatic encephalopathy.
J Hepatology.
1995;
23
39-46
28
Marchesini G, Fabbri A, Bianchi G, Brizi M, Zoli M.
Zinc
supplementation and amino acid-nitrogen metabolism in patients with
advanced cirrhosis.
Hepatology.
1996;
23
1084-1092
30
Michalak A, Chatauret N, Butterworth R F.
Evidence
for a serotonin transporter deficit in experimental acute liver
failure.
Neurochem Int.
2001;
38
163-168
31
Michalak A, Rose C, Butterworth J, Butterworth R F.
Neuroactive
amino acids and glutamate (NMDA) receptors in frontal cortex of
rats with experimental acute liver failure.
Hepatology.
1996;
24
908-913
32
Morgan M Y, Hawley K E.
Lactitol vs.
lactulose in the treatment of acute hepatic encephalopathy in cirrhotic
patients: A double blind, randomized trial.
Hepatology.
1987;
7
1278-1284
33
Naylor C D, O’Rourkee K, Detsky A S, Baker J P.
Parenteral nutrition
with branched-chain amino acids in hepatic encephalopathy. A Meta-Analysis.
Gastroenterology.
1989;
97
1033-1042
34 Orlandi F, Brunelli E, Benedetti A, Macarri G. Clinical trials of nonabsorbable
disaccharide therapy in hepatic encephalopathy. Medi-Ed
Press, Bloomington in: Hepatic encephalopathy.
Syndromes and Therapies. Conn HO and Bircher J. (eds) 1994: 209-218
35
Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller M J.
ESPEN Guidelines
for nutrition in liver disease and transplantation.
Clin
Nutrition.
1997;
16
43-55
37
Quero J C, Hartmann J C, Meulstee J, Hop W C, Schalm S W.
The
diagnosis of subclinical encephalopathy in patients with cirrhosis
using neuropsychological tests and automated electroencephalogram
analysis.
Hepatology.
1996;
24
556-560
38 Raabe W. Neuronal
effects of ammonia. Elsevier, Amsterdam In:
Advances in ammonia metabolism and hepatic encephalopathy. Soeters
P, Wilson JHP, Meijer AF, Holm E (eds) 1988: 349-355
39
Rees C J, Oppong K, Al Mardini H, Hudson M, Record C O.
Effect
of L-ornithine-L-aspartate on patients with and without TIPS undergoing
glutamine challenge: a double blind, placebo controlled trial.
Gut.
2000;
47
571-574
44
Staedt U, Leweling H, Gladisch R, Kortsik C, Hagmuller E, Holm E.
Effects of
ornithine aspartate on plasma ammonia and plasma amino acids in patients
with cirrhosis.
J Hepatol.
1993;
19
424-430
45
Strauss E, Tramote R, Silva E P, Caly W R, Honain N Z, Maffei R A, de Sa M F.
Double-blind
randomized clinical trial comparing neomycin and placebo in the
treatment of exogenous hepatic encephalopathy.
Hepatogastroenterology.
1992;
39
542-545
46
Sushma S, Dasarathy S, Tandon R K, Jain S, Gupta S, Bhist M S.
Sodium benzoate
in the treatment of acute hepatic encephalopathy: a double-blind
randomized trial.
Hepatology.
1992;
16
138-144
47
Tarao K, Ikeda T, Hayashi K, Sakurai A, Okada T, Ito T. et
al .
Successful use of vancomycin hydrochloride in the
treatment of lactulose resistant chronic hepatic encephalopathy.
Gut.
1990;
31
702-706
48
Tromm A, Griga T, Greving I, Hilden H, Huppe D, Schwegler U. et al .
Orthograde whole gut irrigation with mannite
versus paromomycine + lactulose as prophylaxis of hepatic
encephalopathy in patients with cirrhosis and upper gastrointestinal
bleeding: Results of a controlled randomized trial.
Hepatogastroenterology.
2000;
47
473-477
49
Uribe M, Campollo O, Vargas F.
Acidifying enemas (lactitol
and lactulose) vs. nonacidifying enemas (tap water) to treat acute
portal-systemic encephalopathy: A double-blind randomized clinical
trial.
Hepatology.
1987;
7
639-634
50
Uribe M, Marquez M A, Gargaramos G. et al .
Treatment
of chronic portal systemic encephalopathy with lactose in lactase
deficient patients.
Dig Dis Sci.
1980;
25
914-928
51
Van der Rijt C C, Schalm S W, Meulstee J, Stijnen T.
Flumazenil therapy for
hepatic encephalopathy. A double-blind cross over study.
Gastroenterol
Clin Biol.
1995;
19
572-580
52
Van der Rijt C C, Schalm S W, Schat H, Foeken K, De Jong G.
Overt
hepatic encephalopathy precipitated by zinc deficiency.
Gastroenterology.
1991;
100
1114-1118
54
Weber F L, Minco D, Fresard K M, Banwell J G.
Effects of
vegetable diets on nitrogen metabolism in cirrhotic subjects.
Gastroenterology.
1985;
89
538-544
55
Weissenborn K, Rückert N, Hecker H, Manns M P.
The number connection
tests A and B: Interindividual variability and use for the assessment
of early hepatic encephalopathy.
J Hepatol.
1998;
28
646-653
56
Wiltfang J, Nolte W, Otto M, Wildberg J, Bahn E, Figulla H R. et al .
Elevated serum levels of astroglial S100beta
in patients with liver cirrhosis indicate early and subclinical
portal-systemic encephalopathy.
Metab Brain Dis.
1999;
14
239-251
57
Yurdaydin C, Herneth A, Steindl P, Singer E, Ferenci P.
Modulation
of hepatic encephalopathy in rats with thioacetamide-induced acute
liver failure by serotonin antagonists.
Eur J Gastroenterol
Hepatol.
1996;
8
664-671
58
Yurdaydin C, Hörtnagl H, Steindl P, Zimmermann C, Pifl C, Singer E A, Roth E, Ferenci P.
Increased serotoninergic
and noradrenergic activity in hepatic encephalopathy in rats with
thioacetamide induced acute liver failure.
Hepatology.
1990;
12
695-700
