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Management of Neurologic Manifestations in Patients with Liver Disease

  • Neurologic Manifestations of Systemic Disease (N Scolding and C Rice, Section Editors)
  • Published:
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Opinion statement

Liver disease, both in its acute and chronic forms, can be associated with a wide spectrum of neurologic manifestations, both central and peripheral, ranging in severity from subclinical changes to neurocritical conditions. Neurologists are frequently consulted to participate in their management. In this review, we present an overview of management strategies for patients with hepatic disease whose clinical course is complicated by neurologic manifestations. Type A hepatic encephalopathy (HE), which occurs in acute liver failure, is a neurologic emergency, and multiple measures should be taken to prevent and treat cerebral edema. In Type C HE, which occurs in chronic liver disease, management should be aimed at correcting precipitant factors and hyperammonemia. There is an increasing spectrum of drug treatments available to minimize ammonia toxicity. Acquired hepatocerebral degeneration is a rare complication of the chronic form of HE, with typical clinical and brain MRI findings, whose most effective treatment is liver transplantation. Epilepsy is frequent and of multifactorial cause in patients with hepatic disease, and careful considerations should be made regarding choice of the appropriate anti-epileptic drugs. Several mechanisms increase the risk of stroke in hepatic disease, but many of the drugs used to treat and prevent stroke are contraindicated in severe hepatic failure. Hepatitis C infection increases the risk of ischemic stroke. Hemorrhagic stroke is more frequent in patients with liver disease of alcoholic etiology. Viral hepatitis is associated with a wide range of immune-mediated complications, mostly in the peripheral nervous system, which respond to different types of immunomodulatory treatment. Several drugs used to treat hepatic disease, such as the classical and the new direct-acting antivirals, may have neurologic complications which in some cases preclude its continued use.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Blachier M, Leleu H, Peck-Radosavljevic M, Valla D-C, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.

    Article  PubMed  Google Scholar 

  2. Ferro JM, Oliveira S. Neurologic manifestations of gastrointestinal and liver diseases. Curr Neurol Neurosci Rep. 2014;14:487.

    Article  PubMed  Google Scholar 

  3. Sturgeon JP, Shawcross DL. Recent insights into the pathogenesis of hepatic encephalopathy and treatments. Expert Rev Gastroenterol Hepatol. 2014;8:83–100.

    Article  CAS  PubMed  Google Scholar 

  4. Palomero-Gallagher N, Zilles K. Neurotransmitter receptor alterations in hepatic encephalopathy: a review. Arch Biochem Biophys. 2013;536:109–21.

    Article  CAS  PubMed  Google Scholar 

  5. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715–35. The most recently published guidelines with substantial discussion and levels of evidence of different treatment options for hepatic encephalopathy in chronic liver disease.

    Article  PubMed  Google Scholar 

  6. Bernal W, Wendon J. Acute liver failure. N Engl J Med. 2013;369:2525–34. Clear and concise review on the management of acute liver failure.

    Article  CAS  PubMed  Google Scholar 

  7. Polson J, Lee WM. AASLD position paper: the management of acute liver failure: update 2011. Hepatology. 2005;41:1179–97. Most recent practice recommendations for the management of acute liver failure, by the American Association for The Study of Liver Disease.

    Article  PubMed  Google Scholar 

  8. Datar S, Wijdicks EFM. Neurologic manifestations of acute liver failure. Handb Clin Neurol. 2014;120:645–59.

    Article  PubMed  Google Scholar 

  9. Sureka B, Bansal K, Patidar Y, Rajesh S, Mukund A, et al. Neurologic manifestations of chronic liver disease and liver cirrhosis. Curr Probl Diagn Radiol. 2015;44:449–61. Comprehensive review of the neuroimaging abnormalities related to chronic liver disease patients.

    Article  PubMed  Google Scholar 

  10. Karvellas CJ, Fix OK, Battenhouse H, Durkalski V, Sanders C, et al. Outcomes and complications of intracranial pressure monitoring in acute liver failure: a retrospective cohort study. Crit Care Med. 2014;42:1157–67.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vaquero J. Therapeutic hypothermia in the management of acute liver failure. Neurochem Int. 2012;60:723–35.

    Article  CAS  PubMed  Google Scholar 

  12. Bhatia V, Batra Y, Acharya SK. Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure—a controlled clinical trial. J Hepatol. 2004;41:89–96.

    Article  CAS  PubMed  Google Scholar 

  13. Cadranel JF, Lebiez E, Di Martino V, Bernard B, El Koury S, et al. Focal neurological signs in hepatic encephalopathy in cirrhotic patients: an underestimated entity? Am J Gastroenterol. 2001;96:515–8.

    Article  CAS  PubMed  Google Scholar 

  14. Yamamoto Y, Nishiyama Y, Katsura K-I, Yamazaki M, Katayama Y. Hepatic encephalopathy with reversible focal neurologic signs resembling acute stroke: case report. J Stroke Cerebrovasc Dis. 2011;20:377–80.

    Article  PubMed  Google Scholar 

  15. Ben Amor S, Saied MZ, Harzallah MS, Benammou S. Hepatic myelopathy with spastic paraparesis: report of two cases and review of the literature. Eur Spine J. 2014;23 Suppl 2:167–71.

    Article  PubMed  Google Scholar 

  16. Kori P, Sahu R, Jaiswal A, Shukla R. Hepatic myelopathy: an unusual neurological complication of chronic liver disease presenting as quadriparesis. BMJ Case Rep. 2013. doi:10.1136/bcr-2013-009078

  17. Premkumar M, Bagchi A, Kapoor N, Gupta A, Maurya G, et al. Hepatic myelopathy in a patient with decompensated alcoholic cirrhosis and portal colopathy. Case Reports Hepatol. 2012;2012:735906.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cui M, Zhang X, Mu F. Hepatic myelopathy associated with advanced liver cirrhosis. Saudi Med J. 2012;33:1352–4.

    PubMed  Google Scholar 

  19. Baccarani U, Zola E, Adani GL, Cavalletti M, Schiff S, et al. Reversal of hepatic myelopathy after liver transplantation: fifteen plus one. Liver Transpl. 2010;16:1336–7.

    Article  PubMed  Google Scholar 

  20. Guerit JM, Amantini A, Fischer C, Kaplan PW, Mecarelli O, et al. Neurophysiological investigations of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009;29:789–96. Practice recommendations for the neurophysiological investigation of hepatic encephalopathy related to chronic liver disease.

    Article  PubMed  Google Scholar 

  21. Conn HO, Levy LL. The nonspecificity of electroencephalographic triphasic waves: the emperor defrocked. Hepatology. 1989;9:337–8.

    Article  CAS  PubMed  Google Scholar 

  22. Lauridsen MM, Jepsen P, Vilstrup H. Critical flicker frequency and continuous reaction times for the diagnosis of minimal hepatic encephalopathy: a comparative study of 154 patients with liver disease. Metab Brain Dis. 2011;26:135–9.

    Article  PubMed  Google Scholar 

  23. Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, et al. Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int. 2009;29:629–35. Practice guidelines with extensive overview of neuropsychological tests used in hepatic encephalopathy related to chronic liver disease.

    Article  PubMed  Google Scholar 

  24. Mina A, Moran S, Ortiz-Olvera N, Mera R, Uribe M. Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis. Hepatol Res. 2014;44:E92–9.

    Article  PubMed  Google Scholar 

  25. Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ. 2004;328:1046.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Cammà C, Fiorello F, Tinè F, Marchesini G, Fabbri A, et al. Lactitol in treatment of chronic hepatic encephalopathy. A meta-analysis. Dig Dis Sci. 1993;38:916–22.

    Article  PubMed  Google Scholar 

  27. Rahimi RS, Singal AG, Cuthbert JA, Rockey DC. Lactulose vs polyethylene glycol 3350—electrolyte solution for treatment of overt hepatic encephalopathy. JAMA Intern Med. 2014;174:1727.

    Article  CAS  PubMed  Google Scholar 

  28. Eltawil KM, Laryea M, Peltekian K, Molinari M. Rifaximin vs. conventional oral therapy for hepatic encephalopathy: a meta-analysis. World J Gastroenterol. 2012;18:767–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kimer N, Krag A, Møller S, Bendtsen F, Gluud LL. Systematic review with meta-analysis: the effects of rifaximin in hepatic encephalopathy. Aliment Pharmacol Ther. 2014;40:123–32.

    Article  CAS  PubMed  Google Scholar 

  30. Bass NM, Mullen KD, Sanyal A, Poordad F, Neff G, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362:1071–81.

    Article  CAS  PubMed  Google Scholar 

  31. Zhu G-Q, Shi K-Q, Huang S, Wang L-R, Lin Y-Q, et al. Systematic review with network meta-analysis: the comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy. Aliment Pharmacol Ther. 2015;41:624–35.

    Article  CAS  PubMed  Google Scholar 

  32. Gluud L, Dam G, Borre M, Les I. Oral branched-chain amino acids have a beneficial effect on manifestations of hepatic encephalopathy in a systematic review with meta-analyses of randomized controlled trials. J Nutr. 2013;143(8):1263–8.

  33. Bai M, Yang Z, Qi X, Fan D, Han G. l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: a meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2013;28:783–92.

    Article  CAS  PubMed  Google Scholar 

  34. Abid S, Jafri W, Mumtaz K, Islam M, Abbas Z, et al. Efficacy of L-ornithine-L-aspartate as an adjuvant therapy in cirrhotic patients with hepatic encephalopathy. J Coll Physicians Surg Pak. 2011;21:666–71.

    PubMed  Google Scholar 

  35. Sharma K, Pant S, Misra S, Dwivedi M, Misra A, et al. Effect of rifaximin, probiotics, and l-ornithine l-aspartate on minimal hepatic encephalopathy: a randomized controlled trial. Saudi J Gastroenterol. 2014;20:225–32.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Holte K, Krag A, Gluud LL. Systematic review and meta-analysis of randomized trials on probiotics for hepatic encephalopathy. Hepatol Res. 2012;42:1008–15.

    Article  PubMed  Google Scholar 

  37. Jiang Q, Jiang G, Shi K, Cai H, Wang Y, et al. Oral acetyl-L-carnitine treatment in hepatic encephalopathy: view of evidence-based medicine. Ann Hepatol. 2013;12:803–9.

    CAS  PubMed  Google Scholar 

  38. Malaguarnera M, Vacante M, Motta M, Giordano M, Malaguarnera G, et al. Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial. Metab Brain Dis. 2011;26:281–9.

    Article  CAS  PubMed  Google Scholar 

  39. Burkard T, Biedermann A, Herold C, Dietlein M, Rauch M, et al. Treatment with a potassium-iron-phosphate-citrate complex improves PSE scores and quality of life in patients with minimal hepatic encephalopathy: a multicenter, randomized, placebo-controlled, double-blind clinical trial. Eur J Gastroenterol Hepatol. 2013;25:352–8.

    Article  CAS  PubMed  Google Scholar 

  40. Simon-Talero M, Garcia-Martinez R, Torrens M, Augustin S, Gomez S, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol. 2013;59:1184–92.

    Article  CAS  PubMed  Google Scholar 

  41. Rockey DC, Vierling JM, Mantry P, Ghabril M, Brown RSJ, et al. Randomized, double-blind, controlled study of glycerol phenylbutyrate in hepatic encephalopathy. Hepatology. 2014;59:1073–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Wright G, Vairappan B, Stadlbauer V, Mookerjee RP, Davies NA, et al. Reduction in hyperammonaemia by ornithine phenylacetate prevents lipopolysaccharide-induced brain edema and coma in cirrhotic rats. Liver Int. 2012;32:410–9.

    CAS  PubMed  Google Scholar 

  43. Junker AE, Als-Nielsen B, Gluud C, Gluud LL. Dopamine agents for hepatic encephalopathy. Cochrane Database Syst Rev. 2014;2:CD003047.

    PubMed  Google Scholar 

  44. Ampuero J, Ranchal I, Nunez D, Diaz-Herrero M del M, Maraver M, et al. Metformin inhibits glutaminase activity and protects against hepatic encephalopathy. PLoS One. 2012;7:e49279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Amodio P, Canesso F, Montagnese S. Dietary management of hepatic encephalopathy revisited. Curr Opin Clin Nutr Metab Care. 2014;17:448–52.

    Article  PubMed  Google Scholar 

  46. Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology. 2013;58:325–36. Guidelines for nutritional management of hepatic encephalopathy in cirrhosis patients.

    Article  CAS  PubMed  Google Scholar 

  47. An J, Kim KW, Han S, Lee J, Lim Y-S. Improvement in survival associated with embolisation of spontaneous portosystemic shunt in patients with recurrent hepatic encephalopathy. Aliment Pharmacol Ther. 2014;39:1418–26.

    Article  CAS  PubMed  Google Scholar 

  48. García-Martínez R, Rovira A, Alonso J, Jacas C, Simón-Talero M, et al. hepatic encephalopathy is associated with posttransplant cognitive function and brain volume. Liver Transplant. 2011;17:38–46.

    Article  Google Scholar 

  49. Bajaj JS, Schubert CM, Heuman DM, Wade JB, Gibson DP, et al. Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology. 2010;138:2332–40.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Burkhard PR, Delavelle J, Du Pasquier R, Spahr L. Chronic parkinsonism associated with cirrhosis: a distinct subset of acquired hepatocerebral degeneration. Arch Neurol. 2003;60:521–8.

    Article  PubMed  Google Scholar 

  51. Tryc AB, Goldbecker A, Berding G, Rumke S, Afshar K, et al. Cirrhosis-related Parkinsonism: prevalence, mechanisms and response to treatments. J Hepatol. 2013;58:698–705.

    Article  CAS  PubMed  Google Scholar 

  52. Butterworth RF. Parkinsonism in cirrhosis: pathogenesis and current therapeutic options. Metab Brain Dis. 2013;28:261–7.

    Article  CAS  PubMed  Google Scholar 

  53. Meissner W, Tison F. Acquired hepatocerebral degeneration. Handb Clin Neurol. 2011;100:193–7. Review of the most frequent clinical findings and treatment options for acquired hepatocerebral degeneration.

    Article  PubMed  Google Scholar 

  54. Maffeo E, Montuschi A, Stura G, Giordana MT. Chronic acquired hepatocerebral degeneration, pallidal T1 MRI hyperintensity and manganese in a series of cirrhotic patients. Neurol Sci. 2014;35:523–30.

    Article  PubMed  Google Scholar 

  55. Miletić V, Ozretić D, Relja M. Parkinsonian syndrome and ataxia as a presenting finding of acquired hepatocerebral degeneration. Metab Brain Dis. 2014;29:207–9.

    Article  PubMed  Google Scholar 

  56. Criswell SR, Perlmutter JS, Crippin JS, Tom O, Racette BA. Reduced uptake of FDOPA PET in end-stage liver disease with elevated manganese levels. Arch Neurol. 2012;69:394–7.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Ishii K, Shioya A, Fukuda K, Mori K, Tamaoka A. Acquired hepatocerebral degeneration with middle cerebellar peduncles lesions: case report and review of the literature. Clin Neurol Neurosurg. 2012;114:1361–4.

    Article  PubMed  Google Scholar 

  58. Park HK, Kim SM, Choi CG, Lee MC, Chung SJ. Effect of trientine on manganese intoxication in a patient with acquired hepatocerebral degeneration. Mov Disord. 2008;23:768–70.

    Article  PubMed  Google Scholar 

  59. Ueki Y, Isozaki E, Miyazaki Y, Koide R, Shimizu T, et al. Clinical and neuroradiological improvement in chronic acquired hepatocerebral degeneration after branched-chain amino acid therapy. Acta Neurol Scand. 2002;106:113–6.

    Article  CAS  PubMed  Google Scholar 

  60. Lazeyras F, Spahr L, DuPasquier R, Delavelle J, Burkhard P, et al. Persistence of mild parkinsonism 4 months after liver transplantation in patients with preoperative minimal hepatic encephalopathy: a study on neuroradiological and blood manganese changes. Transpl Int. 2002;15:188–95.

    Article  PubMed  Google Scholar 

  61. Hess CW, Saunders-Pullman R. Movement disorders and alcohol misuse. Addict Biol. 2006;11(2):117–25.

  62. Asconapé JJ. Use of antiepileptic drugs in hepatic and renal disease. Handb Clin Neurol. 2014;119:417–32. Review of pharmacokinetic aspects and safety issues for the use of antiepileptic drugs in patients with hepatic disease.

    Article  PubMed  Google Scholar 

  63. Adinolfi LE, Zampino R, Restivo L, Lonardo A, Guerrera B, et al. Chronic hepatitis C virus infection and atherosclerosis: clinical impact and mechanisms. World J Gastroenterol. 2014;20:3410–7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hsu C-S, Kao J-H, Chao Y-C, Lin HH, Fan Y-C, et al. Interferon-based therapy reduces risk of stroke in chronic hepatitis C patients: a population-based cohort study in Taiwan. Aliment Pharmacol Ther. 2013;38:415–23.

    Article  CAS  PubMed  Google Scholar 

  65. Yan P, Zhu A, Liao F, Xiao Q, Kraft AW, et al. Minocycline reduces spontaneous hemorrhage in mouse models of cerebral amyloid angiopathy. Stroke. 2015;46:1633–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Mehndiratta M, Pandey S, Nayak R, Saran RK. Acute onset distal symmetrical vasculitic polyneuropathy associated with acute hepatitis B. J Clin Neurosci. 2013;20:331–2.

    Article  PubMed  Google Scholar 

  67. Monaco S, Ferrari S, Gajofatto A, Zanusso G, Mariotto S. HCV-related nervous system disorders. Clin Dev Immunol. 2012;2012:236148.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Cheung MCM, Maguire J, Carey I, Wendon J, Agarwal K. Review of the neurological manifestations of hepatitis E infection. Ann Hepatol. 2012;11:618–22.

    PubMed  Google Scholar 

  69. El Moutawakil B, Bourezgui M, Rafai MA, Sibai M, Boulaajaj FZ, et al. Acute disseminated encephalomyelitis associated with hepatitis A virus infection. Rev Neurol (Paris). 2008;164:852–4.

    Article  Google Scholar 

  70. Sellner J, Steiner I. Neurologic complications of hepatic viruses. Handb Clin Neurol. 2014;123:647–61.

    Article  PubMed  Google Scholar 

  71. Mengel AM, Stenzel W, Meisel A, Büning C. Hepatitis E induced severe myositis. Muscle Nerve. Published Online First: 29 October 2015.

  72. Perrin HB, Cintas P, Abravanel F, Gérolami R, d’Alteroche L, et al. Neurologic disorders in immunocompetent patients with autochthonous acute hepatitis E. Emerg Infect Dis. 2015;21(11):1928–34.

  73. Bazerbachi F, Haffar S, Garg SK, Lake JR. Extra-hepatic manifestations associated with hepatitis E virus infection: a comprehensive review of the literature. 2015.

    Google Scholar 

  74. Yazaki Y, Sugawara K, Honda M, Ohnishi H, Nagashima S, et al. Characteristics of 20 patients with autochthonous acute hepatitis E in Hokkaido, Japan: first report of bilateral facial palsy following the infection with genotype 4 hepatitis E virus. Tohoku J Exp Med. 2015;236:263–71.

    Article  PubMed  Google Scholar 

  75. Deroux A, Brion JP, Hyerle L, Belbezier A, Vaillant M, et al. Association between hepatitis E and neurological disorders: two case studies and literature review. J Clin Virol. 2014;60:60–2.

    Article  CAS  PubMed  Google Scholar 

  76. Domingos JP, Garrido C, Moreira Silva H, Monteiro C, Silva ES, et al. Chronic inflammatory demyelinating polyneuropathy associated with autoimmune hepatitis. Pediatr Neurol. 2014;51:e13–4.

    Article  PubMed  Google Scholar 

  77. Park KH, Sohn SY, Sung JJ, Lee KW, Hong YH. Subacute sensorimotor polyneuropathy associated with autoimmune hepatitis. J Clin Neurol. 2016;12(1):123–5.

  78. Cacoub P, Comarmond C, Domont F, Savey L, Saadoun D. Cryoglobulinemia vasculitis. Am J Med. 2015;128:950–5.

    Article  PubMed  Google Scholar 

  79. Cacoub P, Terrier B, Saadoun D. Hepatitis C virus-induced vasculitis: therapeutic options. Ann Rheum Dis. 2014;73:24–30. Review of treatment options for hepatitis C virus-induced vasculitis.

    Article  CAS  PubMed  Google Scholar 

  80. Sneller MC, Hu Z, Langford CA. A randomized controlled trial of rituximab following failure of antiviral therapy for hepatitis C virus-associated cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64:835–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. De Vita S, Quartuccio L, Isola M, Mazzaro C, Scaini P, et al. A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64:843–53.

    Article  PubMed  Google Scholar 

  82. Benstead TJ, Chalk CH, Parks NE. Treatment for cryoglobulinemic and non-cryoglobulinemic peripheral neuropathy associated with hepatitis C virus infection. Cochrane Database Syst Rev. 2014;12:CD010404.

    PubMed  Google Scholar 

  83. Ahrens CL, Manno EM. Neurotoxicity of commonly used hepatic drugs. Handb Clin Neurol. 2014;120:675–82. Overview of neurologic complications related to commonly used hepatic drugs.

    Article  PubMed  Google Scholar 

  84. Kowdley KV, Gordon SC, Reddy KR, Rossaro L, Bernstein DE, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370:1879–88.

    Article  PubMed  Google Scholar 

  85. Afdhal N, Reddy KR, Nelson DR, Lawitz E, Gordon SC, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483–93.

    Article  CAS  PubMed  Google Scholar 

  86. Lawitz E, Mangia A, Wyles D, Rodriguez-Torres M, Hassanein T, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013;368:1878–87.

    Article  CAS  PubMed  Google Scholar 

  87. Zeuzem S, Dusheiko GM, Salupere R, Mangia A, Flisiak R, et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014;370:1993–2001.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, University of Lisbon, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal

    José M. Ferro MD, PhD & Pedro Viana MD

  2. University of Lisbon, Lisbon, Portugal

    José M. Ferro MD, PhD

  3. Gastrenterology and Hepatology Service, Hospital de Santa Maria, Lisbon, Portugal

    Patrícia Santos MD

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  1. José M. Ferro MD, PhD
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  2. Pedro Viana MD
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Correspondence to José M. Ferro MD, PhD.

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Pedro Viana and Patrícia Santos declare that they have no conflict of interest.

José M. Ferro has received personal fees from Boheringer Ingelheim and Daiichi Sankyo.

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Ferro, J.M., Viana, P. & Santos, P. Management of Neurologic Manifestations in Patients with Liver Disease. Curr Treat Options Neurol 18, 37 (2016). https://doi.org/10.1007/s11940-016-0419-0

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