Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of cirrhotic patients. MHE patients have normal mental and neurological status on standard clinical examination but exhibit a number of neuropsychiatric and neurophysiological defects, thus causing difficulty in daily tasks including driving etc.

Aim and objective of study: There are few studies conducted in India related to MHE. Hence the present study was undertaken to determine the prevalence of Minimal Hepatic Encephalopathy.

Material and Methods: 50 adult patients with established liver cirrhosis were studied for neuropsychiatric and neurophysiologic tests.

Results: The prevalence of Minimal Hepatic encephalopathy (MHE) was 30% in the study population.

Conclusions: MHE is an significant disorder that may seriously impair patients’ daily functioning and quality of life. MHE predicts the development of overt hepatic encephalopathy. Inspite of the various tools used, in the absence of a “gold standard,” a combination of test methods is recommended to diagnose MHE most reliably. The key point of emphasis is to identify the patients in presymptomatic stage and intervene early enough in order to halt the morbid and fatal future outcomes in liver cirrhotic patients.

Keywords: MHE (minimal hepatic encephalopathy), neurophysiological and neuropsychiatric tests.

1. Stinton LM, Jayakumar S. Minimal hepatic encephalopathy. Canadian Journal of Gastroenterology. 2013;27(10):572-574
2. Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: implications for the assessment of hepatic encephalopathy. Hepatology 2009;50: 2014-2021.
3. Mardini H, Saxby BK, Record CO. Computerized psychometric testing in minimal encephalopathy and modulation by nitrogen challenge and liver transplant. Gastroenterology 2008;135:1582-1590.
4. Bajaj JS, Heuman DM, Sterling RK, et al. Validation of encephalapp , smartphone-based stroop test, for the diagnosis of overt hepatic encephalopathy. Clin Gastroe-nterol Hepatol 2015;13:1828-1835.e1.
5. Tan HH, Lee GH, Thia KTJ, Ng HS, Chow WC, Lui HF. Minimal hepatic encephalopathy runs a fluctuating course: results from a three-year prospective cohort follow-up study. Singapore Med J 2009; 50(3): 255-260
6. Cordoba J, Cabrera J, Lataif L, Pener P, Zee P, Blei AT. High prevalence of sleep disturbances in cirrhosis. Hepatology 1998; 27: 339–45.
7. Weissenborn K, Heidenreich S, Gieweke-meyer K, Ruckert N, Hecker H. Memory function in early hepatic encephalopathy. J.Hepatol.2003;39: 320–5.
8. Prasad S, Dhiman RK, Duseja A, Chawla YK, Sharma A, Agarwal R. Lactulose improves cognitive functions and health-related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy. Hepatology 2007; 45: 549–59.
9. Goeneweg M, Moerland W, Quero JC. Screening of subclinical hepatic encepha-lopathy.J. Hepatology 2000; 32: 748–53.
10. Bajaj JS, Hafeezullah M, Hoffmann RG et al. Navigation skill impairment: Another dimension of the driving difficulties in minimal hepatic encephalopathy. Hepatology 2008; 47: 596–604.
11. Venktaramarao SH, Mittal, Prabhakar S, Dhiman RK. Brain perfusion single photon emission computed tomography (SPECT) abnormalities in patients with minimal hepatic encephalopathy. J Gastroenterol Hepatol 2008; 23 : A62
12. Weissenborn K. Diagnosis of subclinical hepatic encephalopathy. Med SciMonit 1999;5: 568-575.
13. Romero-Gómez M, Córdoba J, Jover R et al. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology 2007; 45: 879–85.
14. Amodio P, Del Piccolo F, Pettenò E et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J. Hepatol. 2001; 35: 37–45.

Dr Pankaj H Bansode

Associate Professor in Surgery,

Bharati Vidyapeeth (Deemed to be University) Medical College, Pune