From the Guidelines
Neuropsychiatric manifestations can persist or emerge after correction of metabolic encephalopathy, and treatment should focus on improving cognitive function and quality of life, with non-absorbable disaccharides being a preferred initial therapy due to their efficacy and safety profile, as suggested by studies such as 1. When managing patients with minimal hepatic encephalopathy (MHE), it is essential to assess the implications of the condition on daily life activities and consider the potential benefits of therapy. The decision to initiate therapy should be based on a critical appraisal of how the patient's daily life could be affected by MHE and improved by therapy. Some key points to consider in the management of MHE include:
- Evaluating the possible benefits of therapy and discussing the value of a 'trial of therapy' with the patient, as outlined in 1
- Selecting therapeutic targets, such as cognitive index and quality of life index, and monitoring them during treatment
- Choosing therapeutic agents, such as non-absorbable disaccharides, neomycin, or rifaximin, and assessing their effectiveness and side effects
- Considering the use of simple symptom questionnaires to monitor quality of life and cognitive functioning, as suggested in 1
- Avoiding situations that may lead to accidents and considering driving restrictions, as recommended in 1 It is crucial to weigh the benefits of therapy against potential side effects and to consider the individual patient's needs and circumstances when making treatment decisions, as emphasized in 1.
From the Research
Neuropsychiatric Manifestations After Correction of Metabolic Encephalopathy
- Metabolic encephalopathies are reversible in most cases, unless secondary complications such as brain herniation occur 2
- The treatment of metabolic encephalopathy generally consists of correcting the underlying systemic illness and supportive measures 2, 3
- Once the underlying cause is corrected, the neuropsychiatric manifestations of metabolic encephalopathy can improve, but the severity and outcome depend on the etiology and severity of the clinical presentation 4, 5
- Some metabolic encephalopathies, such as hepatic encephalopathy, have specific treatment options available 3
- The prognosis of metabolic encephalopathy varies depending on the underlying cause, with mortality rates ranging from 16-65% in cases of septic encephalopathy, and one-year survival rates of less than 50% in patients with encephalopathy and liver cirrhosis 4
- Recognition and treatment of encephalopathy are critical to improving outcomes in critically ill patients, as delirium and encephalopathy have been associated with increased mortality, prolonged length of stay, and worse long-term cognitive and functional outcomes 5