Search

This study is aim to investigate concurrent long-term psychiatric, cognitive and neurophysiological measures of alpha-IFN neurotoxicity in the treatment of chronic viral hepatitis.Twenty patients with HCV hepatitis were enrolled while treated with alpha-IFN (3-6 MU t.i.w. for 6-12 months). Neurotoxicity was evaluated by psychiatric [Hamilton Depression Rating Scale (HAM-D), Hamilton Scale for Anxiety (HAM-A), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI-Y)], complete cognitive and neurophysiological assessments (EEG spectral analysis, P300). Patients were assessed at baseline (t0), 2 (t1) and 6 months (t2) since the beginning of therapy.Depression scores significantly increased (HAM-D: t0=4.4+/-2.6; t1=8.9+/-3.9, p0.001; and t2=7.7+/-3.8, p0.001). A concurrent increase was shown also for anxiety (HAM-A: t0=6.0+/-3.2; t1=9.6+/-4.5, p0.005; and t2=9.1+/-4.5, p0.005). Significant neurophysiological effects were also detected: increase of alpha power (p0.05) in frontal derivations, reduction of the mean dominant frequency (p0.005) and increase of theta power (p0.05) in parietal derivations. In contrast, no significant cognitive changes occurred.The study was performed on a relative small sample of patients mainly with observational intentions. Biological data (e.g. blood cytokines samples) are not available: they could have given useful information about biological mechanisms related to the alterations observed.Alpha-IFN treatment caused a time-dependent induction of symptoms of mild depression, concurrent anxiety and EEG changes. These psychiatric and neurophysiological changes can better explain the pharmacological profile of alpha-IFN and could help to address research on at risk population and, particularly, during pegylated-IFN therapy.

Background/Aims : The electroencephalogram (EEG) is frequently altered in cirrhotic patients. We, therefore, performed a study to ascertain the features and the prognosis of cirrhotic patients without current overt hepatic encephalopathy (OHE) who have EEG alterations. Methods : A series of 296 consecutive cirrhotic patients who had undergone quantified-EEG was studied. The median follow-up was 442 days, 128 patients had bouts of OHE and 78 patients died from liver-related causes. Another group of 124 cirrhotic patients with a median follow-up of 223 days was examined to validate the prognostic model. Results : EEG alterations were detected in 38% of the patients. The prevalence of EEG alterations was associated with the severity of cirrhosis (class B: odds ratio (OR)=2.3, 95% confidence interval (CI)=1.2–4.7; class C: OR=3.5, 95% CI=1.6–7.7), but not with the aetiology (alcoholic vs. non-alcoholic: OR=0.9; 95% CI=0.5–1.5). The EEG predicted the occurrence of OHE ( χ 2 =26; P 0.001) and mortality ( χ 2 =34; P 0.001), also adjusting for Child–Pugh class by a multivariate analysis. In the patients with a Child–Pugh score of ≥ 8, the EEG discriminated between those patients with a higher 1-year risk of OHE (hazard ratio (HR)=3.3, 95% CI=1.8–6.1) and death (HR=3.1, 95% CI=1.7–5.6). Conclusions : In conclusion, quantified-EEG had a prognostic value for the occurrence of bouts of OHE and mortality in cirrhotic patients.