241. Minimal Hepatic Encephalopathy: A Narrative Review
Article type: Literature Review
Article title: Minimal Hepatic Encephalopathy: A Narrative Review
Journal: Cureus
Year: 2026
Authors: Jamir Pitton Rissardo, Fatemeh Rashidi, Hania Moharam, Ibrahim Khalil, Meryem Bahar, Masoumeh Rashidi, Basem Ahmed, Saleh Salem, Ana Leticia Fornari Caprara, Abhishek A. Chouthai, Ahmed M. Kedwany, Hagar H. Sayed, Omesh Prathiraja, Maleesha Jayasinghe
E-mail: jamirrissardo@gmail.com
ABSTRACT
Minimal hepatic encephalopathy (MHE) is primarily a cognitive disorder linked to chronic liver disease that often remains underdiagnosed due to the subtlety of its clinical manifestations. These symptoms are frequently overlooked or dismissed as inconsequential in clinical practice, leading to many undiagnosed cases. The standard neurological examination is usually normal in individuals with MHE. Regular and systematic screening for MHE is essential for early detection, which can improve cognitive outcomes and prevent progression to a more serious and debilitating condition known as overt hepatic encephalopathy. The pathophysiology of MHE is very complex and multifactorial, involving several interacting mechanisms. Mainly, hyperammonemia, systemic inflammation, gut-derived neurotoxins, oxidative stress, and mitochondrial dysfunction are at its root. Any of these factors may interfere with the normal functioning of neurotransmitters, giving rise to the typical subtle cognitive impairments that are hallmarks of MHE. The Animal Naming Test and EncephalApp-Stroop test are practical, rapid, and easily administered tools for screening for minimal hepatic encephalopathy in outpatient and bedside settings. Emerging diagnostic technologies, including advanced neuroimaging techniques and novel biomarkers, have also been investigated and show promise for improving the early detection and diagnosis of MHE.
Keywords: chronic liver diseases, driving impairment, electroencephalography, hepatic encephalopathy, minimal hepatic encephalopathy, neurocognitive testing, neuropsychological testing, psychometric tests, quality of life
Full text available at:
DOI
Citation
Rissardo JP, Rashidi F, Moharam H, Khalil I, Bahar M, Rashidi M, Ahmed B, Salem S, Fornari Caprara AL, Chouthai AA, Kedwany AM, Sayed HH, Prathiraja O, Jayasinghe M. Minimal Hepatic Encephalopathy: A Narrative Review. Cureus 18(8): e113978. doi:10.7759/cureus.113978.
Figure 1. Grades of hepatic encephalopathy.
Figure 2. Role of ammonia in the pathophysiology of hepatic encephalopathy.
Figure 3. The algorithm for arriving at the diagnostically appropriate diagnosis of minimal hepatic encephalopathy.
Figure 4. Proposed clinical algorithm for the diagnosis of minimal hepatic encephalopathy.
Table 1. Diagnostic methods for the detection of MHE. ANT: Animal Naming Test, CFF: critical flicker frequency testing, CHE: covert hepatic encephalopathy, CRT: Continuous Response Time test, EEG: electroencephalography, HRQOL: health-related quality of life, ICT: Inhibitory Control Test, MHE: minimal hepatic encephalopathy, PHES: Psychometric Hepatic Encephalopathy Score, RBANS: Repeatable Battery for the Assessment of Neuropsychological Status, SIP: Sickness Impact Profile, 3-NT: 3-nitrotyrosine.
Table 2. Precipitating factors diagnosis and management. BRTO: Balloon-Occluded Transvenous Retrograde TIPS: transjugular intrahepatic portosystemic shunt, SPSS: spontaneous portosystemic shunt, BRTO: balloon-occluded retrograde transvenous obliteration, CARTO: coil-assisted retrograde transvenous obliteration, PARTO: plug-assisted retrograde transvenous obliteration, HE: hepatic encephalopathy, IV: intravenous, BMI: body mass index, DEXA: dual-energy X-ray absorptiometry, GI: gastrointestinal, PPI: proton pump inhibitor.Obliteration, CARTO: Coil-Assisted Retrograde Transvenous Obliteration, PARTO: Plug-assisted BRTO.
Table 3. Published studies on the management of minimal hepatic encephalopathy. BCAA: branched-chain amino acids, BDT: block design test, CFF: critical flicker frequency, CEP: cognitive evoked potentials, DST: digit symbol test, EEG: electroencephalogram, FOS: fructooligosaccharide, HRQOL: health-related quality of life, ICT: inhibitory control test, LTT: line tracing test, MHE: minimal hepatic encephalopathy, NCT-A: number connection test-A, NCT-B: number connection test-B, NfL: Neurofilament light, OHE: overt hepatic encephalopathy, PHES: psychometric hepatic encephalopathy score, SDT: serial dotting test, SIBO: small intestinal bacterial overgrowth.
240. Effects of subthalamic nucleus deep brain stimulation on sleep quality and daytime sleepiness in Parkinson’s disease: a systematic review and meta‑analysis
Article type: Systematic Review
Article title: Effects of subthalamic nucleus deep brain stimulation on sleep quality and daytime sleepiness in Parkinson’s disease: a systematic review and meta‑analysis
Journal: Neurological Research
Year: 2026
Authors: Jamir Pitton Rissardo, Mansi Jain, and Ana Letícia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for motor symptoms in Parkinson’s disease (PD), but its effects on sleep remain uncertain. This study evaluated changes in nocturnal sleep quality and daytime sleepiness following STN-DBS. Methods: Four databases were searched for longitudinal studies assessing sleep outcomes after STN-DBS in PD. Sleep was evaluated using the Parkinson’s Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS). Study quality was assessed with the Newcastle-Ottawa Scale. Pooled mean differences (MDs) were calculated using inverse-variance fixed-effects models, and heterogeneity was assessed with I2 statistics. Results: Nine studies reporting PDSS outcomes (n = 286) and eight reporting ESS outcomes (n = 190) were included. Most patients underwent bilateral STN-DBS (93.7%). Pooled analyses demonstrated significant improvements in PDSS scores (MD 21.23 points, 95% CI 11.59–30.87; p < 0.01) and reductions in ESS scores (MD − 3.62 points, 95% CI − 5.09 to −2.14; p < 0.01). Heterogeneity was negligible for both outcomes (τ = 0; I2 = 0%). The 95% prediction intervals remained favorable for PDSS (9.61–32.86) and ESS (−5.46 to −1.77), suggesting consistent findings across studies. Conclusion: Current evidence suggests that STN-DBS is associated with improved subjective sleep quality and reduced daytime sleepiness in patients with PD. However, these findings should be interpreted cautiously because they are derived primarily from observational studies with limited sample sizes and potential confounding factors. Prospective studies specifically designed to evaluate sleep outcomes are needed to clarify the independent effects of STN-DBS on sleep.
Keywords: Parkinson’s disease; subthalamic nucleus; deep brain stimulation; sleep quality; daytime sleepiness; non‑motor symptoms.
Full text available at:
DOI
Citation
Rissardo J P, Jain M, Fornari Caprara AL. Effects of subthalamic nucleus deep brain stimulation on sleep quality and daytime sleepiness in Parkinson’s disease: a systematic review and meta‑analysis. Neurol Res 2026, 1–19. https://doi.org/10.1080/01616412.2026.2717709
Figure 1. PRISMA screening flow diagram.
Figure 2. Forest plot of pooled mean change from baseline in MD of PDSS scores after STN-DBS.
Figure 3. Forest plot of pooled mean change from baseline in MD of ESS scores after STN-DBS.
Table 1. Study characteristics of meta-analysis studies.
Table 2. NOS.
Table 3. Certainty of evidence.
Table 4. Quantitative evidence on sleep outcomes after STN‑DBS in PD.
.png)
Abstracts - 2026
2026
AAPM Pain Connect - Salt Lake City
Spinal Cord Stimulation in Parkinson’s Disease: Beyond Motor Control—A Path to Pain Relief
Beyond Motor Control: Deep Brain Stimulation Significantly Reduces Pain in Parkinson’s Disease
MDS PAS 2026 - Houston
World Parkinson Congress - Phoenix
ACNS Annual Meeting - New Orleans
Successful Surgical Treatment of Radiation-Induced Epilepsy Using sEEG: A Case Report
EEG-Guided Anesthesia in Cardiothoracic Surgery: Does BIS Improve Neurological Outcomes?
Meta-Analysis of Auricular VNS in Drug-Resistant Epilepsy: What Do Randomized Trials Reveal?
Smartphone Videos for Seizure Diagnosis: High Specificity Compared to cEEG
Centromedian Thalamic Deep Brain Stimulation in Epilepsy: Does It Really Work? A Meta-Analysis of Clinical Outcomes
Rowan Research Day - Stratford
Cerebrospinal Fluid and Serum Manganese Levels in Parkinson’s Disease: A Method‑Stratified Meta‑analysis
Effects of Subthalamic Nucleus Deep Brain Stimulation on Depressive Symptoms in Patients with Parkinson’s Disease: A Meta‑Analysis
Efficacy and Safety of Droxidopa for Neurogenic Orthostatic Hypotension: A Systematic Review and Meta‑analysis
Efficacy and Safety of Levetiracetam for Essential Tremor: A Systematic Review and Meta‑Analysis
Focal Status Epilepticus in a Patient with Responsive Neurostimulation: A Rare Complication and Management Insights
Irritability and Related Behavioral Adverse Events Associated With Levetiracetam: A Meta‑Analysis and Meta‑Regression of Randomized Trials
Missense Mutations in the SNCA Gene: Molecular Mechanisms and Clinical Implications
Prevalence and Clinical Correlates of Restless Legs Syndrome in Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta‑analysis
Trends and Disparities in Mortality Involving Epilepsy and Aspiration Pneumonia Among Older Adults in the United States, 1999–2020
Wearable and Technology‑Assisted Gait and Balance Interventions in Parkinson’s Disease: A Systematic Review and Meta‑Analysis
AAN - Chicago
Comparing the Efficacy and Safety of Endovascular Therapy versus Best Medical Treatment in Patients with Distal Medium Vessel Occlusion: A Systematic Review and Meta-Analysis
AAIC - London, UK
Harnessing Gamma: Randomized Placebo-controlled Evidence For 40 Hz Sensory Stimulation In Alzheimer’S Disease
Repetitive Transcranial Magnetic Stimulation In Severe Alzheimer Disease: A Meta-analytic Evaluation Of Cognitive Outcomes
Do Csf aβ42 Increases Predict Cognitive Benefit? Evidence From Alzheimer’s Disease Trials
P2P - Phoenix
ATMRD - Washington, D.C.
Efficacy and Safety of Riluzole in Huntington’s Disease: A Systematic Review and Meta‑analysis of Placebo‑Controlled Clinical Trials
Retinal Structural Changes in Huntington Disease: An OCT‑Based Meta‑analysis
Three Decades of U.S. Huntington’s Disease Mortality: National Age‑ and Sex‑Specific Trends
Clinical Effects of Perampanel in Parkinson’s Disease: Evidence from Controlled Trials
Effects of Traditional Acupuncture on Motor and Nonmotor Symptoms in Parkinson’s Disease: A Placebo‑Controlled Meta‑analysis
Efficacy and Safety of Curcumin Supplementation in Parkinson’s Disease: A Meta‑Analysis of Randomized Controlled Trials
MDS International Congress - Seoul, Korea
Smell as a Diagnostic Signature: Systematic Review and Meta-Analysis of UPSIT Accuracy in Distinguishing Parkinson’s Disease from Essential Tremor
Telerehabilitation Versus Conventional Therapy in Parkinson’s Disease: Evidence from Randomized Controlled Trials
Subthalamic Deep Brain Stimulation Produces Consistent Improvements in Sleep Quality and Daytime Sleepiness in Parkinson’s Disease: A Systematic Review and Meta-analysis
Comparative Motor Response to Bilateral STN‑DBS in LRRK2‑Related and Idiopathic Parkinson’s Disease
Effects of Modafinil on Motor and Non‑Motor Outcomes in Parkinson’s Disease: A Meta‑Analysis of Randomized, Placebo‑Controlled Trials
Efficacy and Safety of Inhaled and Sublingual Apomorphine for On-Demand Treatment of OFF Episodes in Parkinson’s Disease: A Meta‑Analysis of Randomized Placebo‑Controlled Trials
Efficacy and Adverse Events of Tetrabenazine, Deutetrabenazine, and Valbenazine in Huntington’s Disease
Clinical Impact of Nicotine in Parkinson’s Disease: Evidence from Randomized Controlled Studies
Motor and Quality‑of‑Life Outcomes After MR‑Guided Focused Ultrasound Subthalamotomy for Parkinson’s Disease: A Meta‑analysis
Ketogenic Diet and Motor Outcomes in Parkinson’s Disease: A Meta-analysis of Randomized Trials
Efficacy and Safety of Ecopipam for Tourette Syndrome: A Meta‑analysis of Controlled Trials
A Meta-analysis of Tonic Motor Activation (TOMAC) Therapy for Restless Legs Syndrome
Efficacy and Safety of Mesdopetam (IRL790) for Levodopa‑Induced Dyskinesia in Parkinson’s Disease: A Meta‑analysis of Randomized Controlled Trials
Efficacy of Vitamin C for Restless Legs Syndrome: A Systematic Review and Meta‑analysis of Randomized Controlled Trials
Antidepressants in Huntington’s Disease: A Meta‑Analysis of Mood and Motor Outcomes with Placebo-controlled Trials
Risk of Deep Venous Thrombosis in Patients With Parkinson’s Disease: A Meta‑Analysis of Observational Studies
Bidirectional Association Between Gout and Parkinson’s Disease: A Systematic Review and Meta-Analysis
Escitalopram for Depression and Motor Symptoms in Parkinson’s Disease: A Systematic Review and Meta‑analysis
ISFTD - Philadelphia, PA
Cerebrospinal Fluid and Blood Neurofilament Light Chain in Behavioral Variant Frontotemporal Dementia: A Systematic Review and Meta‑Analysis
C9orf72-Associated Parkinsonism: Defining a Multisystem Neurodegenerative Spectrum
ANA - San Diego, CA
Deferiprone in Parkinson’s Disease: Motor, Imaging, and Safety Outcomes Across Randomized Trials
Levetiracetam Versus Phenobarbital as First‑Line Therapy for Neonatal Seizures: A Meta‑analysis of Randomized Controlled Trials
Abstracts - 2025
2025
AANS - Boston
AAN - San Diego
MDS International Congress - Hawaii, USA
The Impact of Statin Therapy on Motor and Non-Motor Symptoms in Parkinson’s Disease: A Meta-Analysis
CNS - LA
AES - Atlanta
.png)
.png)
Subscribe to:
Posts (Atom)