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European Spine Journal

, Volume 22, Issue 10, pp 2340–2340 | Cite as

Letter to the editor concerning “hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature” by S. Ben Amor et al. (Eur Spine J. 2013, Jun 1)

  • Raffaele NardoneEmail author
  • Stefan Golaszewski
  • Yvonne Höller
  • Francesco Brigo
  • Eugen Trinka
Letter to the Editor
  • 621 Downloads

Keywords

Spinal Cord Transcranial Magnetic Stimulation Corticospinal Tract Motor Evoke Potential Spastic Paraparesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

To the Editor,

We read with great interest the article by Ben Amor et al. [1] published in the European Spine Journal entitled “Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature”. The authors state in their paper that there is no special diagnostic tool for hepatic myelopathy (HM), and that the diagnosis has to be established on clinical grounds after exclusion of other possible entities. However, in our opinion, there is a noticeable omission in this important article. Our previous study [2] revealed that motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) may be very helpful in the diagnosis of this rare complication of chronic liver diseases that is usually associated with a portosystemic shunt and likely to be overlooked. The authors demonstrated that central motor conduction studies by means of TMS are sensitive, accurate and easily applicable methods for detecting even a subclinical damage of the corticospinal tract. The threshold for corticospinal electrophysiological abnormalities was below that for clinical and/or radiological changes. Spinal cord involvement was evident even at the preclinical stage and became more overt as the disease progressed. Most of the examined patients did not have clinical symptoms and presented only physiological subclinical abnormalities.

MEP studies may thus disclose an impairment of the corticospinal pathways even before HM is clinically manifest and enable an early diagnosis of HM. Since, liver transplantation (the first therapeutic option) should be performed before spinal cord damage becomes irreversible [3, 4, 5], the diagnosis of HM must be established as early as possible to enhance the chance of a complete recovery of the spinal cord. Therefore, we believe that such an important examination, which is at present widely and easily performed in the most neurophysiology laboratories, cannot be neglected. We found important to highlight that, especially in a review article on HM, this important diagnostic tool should be included and discussed.

Notes

Conflict of interest

None.

References

  1. 1.
    Ben Amor S, Saied MZ, Harzallah MS, Benammou S (2013) Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature. Eur Spine J [Epub ahead of print]Google Scholar
  2. 2.
    Nardone R, Buratti T, Oliviero A, Lochmann A, Tezzon F (2006) Corticospinal involvement in patients with a portosystemic shunt due to liver cirrhosis: a MEP study. J Neurol 253:81–85PubMedCrossRefGoogle Scholar
  3. 3.
    Counsell C, Warlow C (1996) Failure of presumed hepatic myelopathy to improve after liver transplantation. J Neurol Neurosurg Psychiatry 60:590PubMedCrossRefGoogle Scholar
  4. 4.
    Troisi R, Debruyne J, de Hemptinne B (1999) Improvement of hepatic myelopathy after liver transplantation. N Engl J Med 340:151PubMedCrossRefGoogle Scholar
  5. 5.
    Weissenborn K, Tietge UJ, Bokemeyer M, Mohammadi B, Bode U, Manns MP, Caselitz M (2003) Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology 124:346–351PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Raffaele Nardone
    • 1
    • 2
    • 3
    Email author
  • Stefan Golaszewski
    • 1
    • 3
  • Yvonne Höller
    • 1
    • 3
  • Francesco Brigo
    • 2
  • Eugen Trinka
    • 1
    • 3
  1. 1.Department of Neurology, Christian Doppler KlinikParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of NeurologyFranz Tappeiner HospitalMeranoItaly
  3. 3.Spinal Cord Injury and Tissue Regeneration CenterParacelsus Medical UniversitySalzburgAustria

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