Minimal hepatic encephalopathy: A review

Raffaele Nardone*, Alexandra C. Taylor, Yvonne Höller, Francesco Brigo, Piergiorgio Lochner, Eugen Trinka

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

29 Citations (Scopus)


Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of patients with liver cirrhosis. By definition, MHE is characterized by cognitive function impairment in the domains of attention, vigilance and integrative function, but obvious clinical manifestation are lacking. MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis can be achieved through neuropsychological testing, recently developed computerized psychometric tests, such as the critical flicker frequency and the inhibitory control tests, as well as neurophysiological procedures. Event related potentials can reveal subtle changes in patients with normal neuropsychological performances. Spectral analysis of electroencephalography (EEG) and quantitative analysis of sleep EEG provide early markers of cerebral dysfunction in cirrhotic patients with MHE. Neuroimaging, in particular MRI, also increasingly reveals diffuse abnormalities in intrinsic brain activity and altered organization of functional connectivity networks. Medical treatment for MHE to date has been focused on reducing serum ammonia levels and includes non-absorbable disaccharides, probiotics or rifaximin. Liver transplantation may not reverse the cognitive deficits associated with MHE. We performed here an updated review on epidemiology, burden and quality of life, neuropsychological testing, neuroimaging, neurophysiology and therapy in subjects with MHE.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalNeuroscience Research
Publication statusPublished - 1 Oct 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Ireland Ltd and Japan Neuroscience Society

Other keywords

  • Electroencephalography
  • Event related potentials
  • Hepatic encephalopathy
  • Magnetic resonance imaging
  • Minimal hepatic encephalopathy
  • Neuropsychological testing


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