BOSTON—Parkinsonism occurs in 52% of patients with liver cirrhosis, and a liver transplantation may significantly improve motor symptoms, gait, and bradykinesia in this population, according to a study presented at the 2012 Annual Meeting of the American Neurological
Association.
Patients’ mean total Unified Parkinson’s Disease Rating Scale (UPDRS) score was 31 at baseline, compared with 16 at one year after liver transplantation, said Diana Apetauerova, MD, a neurologist at the Lahey Clinic in Burlington, Massachusetts. Participants’ mean motor total score was 15 at baseline, compared with 7 at one year after transplantation, and the mean bradykinesia score was 8 at baseline, compared with 4 at one year after transplantation.
T1 basal ganglia hyperintensity was a statistically significant MRI biomarker in patients with liver cirrhosis and parkinsonism that resolved within one year following transplantation. Large decreases in MRI ratios were associated with large declines in motor UPDRS scores, but the correlation was not statistically significant, possibly because of the small sample size, noted the investigators.
A Prospective Study of Parkinsonism Prevalence and Liver Cirrhosis
Dr. Apetauerova and colleagues prospectively studied 120 patients with liver cirrhosis to determine the prevalence of parkinsonism in this population and seek correlations between cirrhosis severity and neuroradiologic and biologic findings. Patients underwent UPDRS testing at baseline and at six weeks, three months, and 12 months following liver transplantation. Patients with parkinsonism also underwent brain MRI before transplantation and one year after transplantation. Researchers measured the correlation between severity of liver disease and UPDRS motor scores, as well as copper, ammonia, manganese, and iron levels.
In a substudy, investigators blindly evaluated brain MRIs of patients with hepatocerebral degeneration and compared them with brain MRIs of a matched cohort of patients with Parkinson’s disease.
Of the 120 patients with liver cirrhosis, 83 were male and 62 had parkinsonism. Patients’ mean age was approximately 55, and their mean disease duration was about seven years.
Cirrhosis Severity Not Correlated With Motor Score
The investigators found no correlation between severity of liver disease and UPDRS motor score. Severity of liver disease was also not correlated with levels of copper, ammonia, manganese, or iron. Mean iron level, however, was higher in patients with parkinsonism than in patients without parkinsonism.
The researchers observed no statistically significant changes in symptoms at six weeks after transplantation, but did note clinical improvements in bradykinesia, gait, and UPDRS score. Statistically significant changes in bradykinesia, gait, motor scores, and UPDRS scores were evident at three months after transplantation, as were slight improvements in tremor and
rigidity.
Before transplantation, 59% of patients with hepatocerebral degeneration had increased pituitary T1 signal, compared with 7% of patients with Parkinson’s disease. The increased signal resolved after transplantation. The investigators observed statistical differences in the thalamus and white matter between patients with hepatocerebral degeneration before transplantation and patients with Parkinson’s disease.
“We are trying to see more patients, because I think there will, at the end, be a correlation between the MRI abnormalities and the clinical picture,” Dr. Apetauerova told Neurology Reviews. Dopaminergic transporter imaging ultimately could reveal what percentage of patients with liver cirrhosis have pathway abnormalities similar to those of patients with Parkinson’s disease, she added.
—Erik Greb