Bromocriptine in the Treatment of Chronic Hepatic Encephalopathy

  • M. Y. Morgan

Abstract

Chronic hepatic encephalopathy (chronic porto-systemic encephalopathy) is a neuropsychiatric syndrome which occurs as well-recognised though rare complication of chronic liver disease.1–5 Patients show persistent clinical, psychometric and electroencephalographic evidence of encephalopathy and often present as neurological rather than hepatic problems. Profound changes in central neurotransmitters, particularly of the adrenergic system have been documented in these patients,6,7 including decreased concentrations of norepinephrine and dopamine and increased concentrations of the week neurotransmitters octopamine and β-phenylethanolamine.8–10 Changes also occur in cerebral energy metabolism, namely a fall in cerebral blood flow and cerebral oxygen consumption11,12 together with an abnormality of glucose handling.13 Clinical improvement is associated with an increase in oxygen utilization.11,12,14

Keywords

Placebo Dopamine Norepinephrine Neurol Alkaloid 

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References

  1. 1.
    S. Sherlock, W. H. J. Summerskill, L. P. White and E. A. Phear, Portal systemic encephalopathy. Neurological complications of liver disease, Lancet 2: 453 (1954).CrossRefGoogle Scholar
  2. 2.
    W. V. McDermott, Jr. and R. D. Adams, Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia, J. Clin. Invest. 33: 1 (1954).PubMedCrossRefGoogle Scholar
  3. 3.
    W. H. J. Summerskill, E. A. Davidson, S. Sherlock, and R. E. Steiner, The neuropsychiatric syndrome associated with hepatic cirrhosis and an extensive portal collateral circulation, Q. J. Med. 25: 245 (1956).Google Scholar
  4. 4.
    M. Victor, R. D. Adams, and M. Cole, The acquired (non-Wilsonian) type of chronic hepato-cerebral degeneration, Medicine 44: 345 (1965).PubMedCrossRefGoogle Scholar
  5. 5.
    A. E. Read, S. Sherlock, J. Laidlow, and J. G. Walker, The neuropsychiatric syndrome associated with chronic liver disease and an extensive portal-systemic collateral circulation, Q. J. Med. 36: 135 (1967).Google Scholar
  6. 6.
    R. J. Baldessarini and J.E. Fischer, Serotonin metabolism in rat brain after surgical diversion of the portal venous circulation, Nature New Biol. 254: 25 (1973).Google Scholar
  7. 7.
    J. M. Dodsworth, J. H. James, M. C. Commungs, and J. E. Fischer, Depletion of brain norepinephrine in acute hepatic coma, Surgery 75: 811 (1974).PubMedGoogle Scholar
  8. 8.
    J. E. Fischer and R. J. Baldessarini, False neurotransmitters and hepatic failure, Lancet 2: 75 (1971).PubMedCrossRefGoogle Scholar
  9. 9.
    K. C. Lam, A. R. Tall, G. B. Goldstein, and S. F. Mistilis, The role of a false neurochemical transmitter, octopamine, in the pathogenesis of hepatic and renal encephalopathy, Scand. J. Gastroenterol. 8: 465 (1973).Google Scholar
  10. 10.
    K. K. Manghani, M. R. Lunzer, B. H. Billing, and S. Sherlock, Urinary and serum octopamine in patients with porto-systemic encephalopathy, Lancet 2: 943 (1975).PubMedCrossRefGoogle Scholar
  11. 11.
    J. F. Fazekas, H. E. Ticktin, W. R. Ehrmantraut, and R. W. Altman, Cerebral metabolism in hepatic insufficiency, Am. J. Med. 21: 843 (1956).PubMedCrossRefGoogle Scholar
  12. 12.
    J. B. Posner and F. Plum, The toxic effects of carbon dioxide and acetazolamide in hepatic encephalopathy, J.Clin. Invest. 39: 1246 (1960).CrossRefGoogle Scholar
  13. 13.
    I. M. James, S. Nashat, D. Sampson, H. S. Williams, and M. Garassini, Effect of induced metabolic alkalosis in hepatic encephalopathy, Lancet 2: 1106 (1969).PubMedCrossRefGoogle Scholar
  14. 14.
    E. Polli, G. Bianchi Porro, and A. T. Maiolo, Cerebral metabolism after portocaval shunt, Lancet 1: 1341 (1969).Google Scholar
  15. 15.
    T. Hökfelt and K. Fuxe, Effects of prolactin and ergot alkaloids on the tubero-infundibular dopamine (DA) neurons, Neuroendocrinology 9: 100 (1972).PubMedCrossRefGoogle Scholar
  16. 16.
    M. Y. Morgan, A. W. Jakabovits, I. M. James, and S. Sherlock, Successful use of bromocriptine in the treatment of chronic hepatic encephalopathy, Gastroenterology 78: 663 (1980).PubMedGoogle Scholar
  17. 17.
    D. Jones and J. Weinman, Computer based psychological testing, in: “Human and Artificial Intelligence”, D. Jones and A. Elithorn, eds., Elsevier, Amsterdam (1973).Google Scholar
  18. 18.
    D. J. Wyper, G. A. Lennox, and J. O. Rowan, Two minute slope inhalation technique for cerebral blood flow measurement in man 1. Method, J. Neurol. Neurosurg. Psychiatry 39: 141 (1976).CrossRefGoogle Scholar
  19. 19.
    D. J. Wyper and J. O. Rowan, The construction and use Ti nomograms for cerebral blood flow calculations using a 3Xe inhalation technique, Phys.Med.Biol. 21: 406 (1976).PubMedCrossRefGoogle Scholar
  20. 20.
    A. W. Marshall, A. W. Jacobovits, and M. Y. Morgan, Bromocriptine-associated hyponatraemia in cirrhosis, Br. Med. J. in press (1982).Google Scholar
  21. 21.
    J. McCulloch and A. M. Harper, Dopaminergic systems and the cerebral circulation, Acta Neurol. Scand. (Suppl.) 56: (64) 100 (1977).Google Scholar
  22. 22.
    L. Edvinsson, J. E. Hardebo, A. M. Harper, J. McCulloch, and Ch. Owman, Action of dopamine agonist on brain vessels in vitro and after in vivo micropuncture, Acta Neurol. Scand. (Suppl.) 56 (64): 350 (1977).Google Scholar
  23. 23.
    A. G. Boulu, M. Plotkine, and C. Gueniau, Effects of dopaminergic agonists upon oxygen availability for cerebral cortex, Acta Neurol. Scand. (Suppl.) 56 (64): 352 (1977).Google Scholar
  24. 24.
    L. Zieve, W. M. Doizaki, and R. F. Derr, Reversal of ammonia coma by L-dopa: a peripheral effect, Gut 20: 28 (1979).PubMedCrossRefGoogle Scholar
  25. 25.
    M. Uribe, A. Farca, M. A. Marquez, G. Garcia-Romos, L. Guevara, A. Briones, and S. Gils, Treatment of chronic portal systemic encephalopathy with bromocriptine, Gastroenterology 76: 1342 (1979).Google Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • M. Y. Morgan
    • 1
  1. 1.Department of MedicineRoyal Free Hospital School of MedicineHampstead, LondonGreat Britain

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