From the Guidelines
Neurological deficits in patients with hepatic encephalopathy can manifest as a wide range of nonspecific neurological and psychiatric manifestations, including alterations in consciousness, motor function, and cognitive abilities, as well as extrapyramidal dysfunction and asterixis. According to the 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver 1, common neurological deficits include:
- Motor system abnormalities, such as hypertonia, hyper-reflexia, and a positive Babinski sign
- Extrapyramidal dysfunction, such as hypomimia, muscular rigidity, bradykinesia, hypokinesia, monotony and slowness of speech, parkinsonian-like tremor, and dyskinesia with diminished voluntary movements
- Asterixis or “flapping tremor”, a negative myoclonus consisting of loss of postural tone
- Cognitive deficits, such as alterations in attention, working memory, psychomotor speed, and visuospatial ability
- Personality changes, such as apathy, irritability, and disinhibition
- Disturbances of the sleep-wake cycle with excessive daytime sleepiness
- Progressive disorientation to time and space, inappropriate behavior, and acute confusional state with agitation or somnolence, stupor, and, finally, coma. It is essential to note that the mental and motor signs of hepatic encephalopathy may not be expressed or progress in parallel in each individual, making it challenging to stage the severity of the condition. In contrast, a more recent study on vascular cognitive impairment 1 highlights the importance of considering noncognitive neurological deficits, such as visual field deficits and motor deficits, when performing cognitive assessments. However, based on the most recent and highest quality study available, the neurological deficits in patients with hepatic encephalopathy are primarily related to the severity of the condition and can be reversible with appropriate treatment 1.
From the FDA Drug Label
Falling Asleep During Activities of Daily Living and Somnolence Patients taking carbidopa and levodopa orally disintegrating tablets alone or with other dopaminergic drugs have reported suddenly falling asleep without prior warning of sleepiness while engaged in activities of daily living NMS is an uncommon but life-threatening syndrome characterized by fever or hyperthermia Neurological findings, including muscle rigidity, involuntary movements, altered consciousness, mental status changes;
The neurological deficits associated with levodopa (PO) include:
- Sudden onset of sleep: without prior warning of sleepiness
- Somnolence: drowsiness or sleepiness
- Muscle rigidity: a symptom of neuroleptic malignant syndrome (NMS)
- Involuntary movements: a symptom of NMS
- Altered consciousness: a symptom of NMS
- Mental status changes: a symptom of NMS 2
From the Research
Neurological Deficits
The neurological deficits can be categorized into several types, including:
- Sensory deficits, which can result from damage to the central nervous system (CNS) 3
- Motor deficits, which can manifest as gait and balance disturbances, tremor, reduced arm swing and finger movement, and voice and breathing changes 4
- Anosognosia, which is a syndrome of unawareness for sensory and motor neurological deficits 5
Causes of Neurological Deficits
The causes of neurological deficits can be grouped into several categories, including:
- Congenital conditions, such as hydrocephalus, spina bifida, and Arnold-Chiari malformation 3
- Traumatic conditions, such as cerebral concussion, contusion, laceration, and hematomas 3
- Inflammatory conditions, such as brain abscess, meningitis, and transverse myelitis 3
- Neoplastic conditions, such as meningioma, neurofibroma, and gliomas 3
- Degenerative conditions, such as Parkinson's disease [(4,6,7)]
Motor Deficits in Parkinson's Disease
Motor deficits in Parkinson's disease can include: