Default Mode Network fMRI Maps as a Predictive Index of Hepatic Encephalopathy Outcome

Recruitment & Eligibility

Inclusion Criteria

Patient or legally acceptable representative must understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (PHI) in accordance with national and local patient privacy regulations.
Age 18 or older at the time of informed consent.
Patients with liver cirrhosis attending the gastroenterology department (inpatient or outpatient) with hepatic encephalopathy from various causes of liver failure (i.e. alcoholic, infectious, carcinomatous or toxic).
The patients will be selected applying Child Pughs score and West Raven classification for hepatic encephalopathy.
All patients participating in the study will undergo a full neurological exam, 30 min routine EEG recording and neuropsychological evaluation along with the f-MRI study.

(Hepatic Encephalopathy Group)

Exclusion Criteria

History of alcohol consumption or illicit drug use within past 3 months.
Patients with underlying psychiatric or neurologic illness (i.e. schizophrenia, untreated major depressive disorder, epilepsy, neurodegenerative dementia, etc.) resulting in unrelated to encephalopathy impairment of consciousness and/or alteration of normal mental capacity.
Patients after head injury or with advanced pulmonary, renal, or other than liver failure metabolic disorder (such as severe hypoxia, hypo/hyperglycemia, metabolic acidosis or alkalosis).
Patients requiring sedation for MRI.
Pregnant women.

(Normal Control Group)

Inclusion Criteria:

Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information (PHI) in accordance with national and local subject privacy regulations.
Be age 18 or older at the time of informed consent.
Subjects must be right handed, be free from any neurological injury, be free from any neurological diseases, be free from any psychological diseases, have a baseline Blood pressure < 140/90, not currently be taking any mind altering medications (including antidepressants, anxiolytics, or opioid/narcotic pain medications), and not have claustrophobia

(Normal Control Group)

Exclusion Criteria:

Unwillingness or inability to comply with the requirements of this protocol, including the presence of any condition (physical, mental, or social) that is likely to affect the subject's ability to comply with the study protocol.
History of alcohol consumption 1 week prior to the MRI.
Illicit drug use within past 3 months.
Patients requiring sedation for MRI.
Pregnant women.
Any other condition, clinical finding, or reason that, in the opinion of the Investigator, is determined to be unsuitable for enrollment into this study.

Study & Design

Primary Outcome Measures

Name	Time	Method
Functional MRI imagining	Participants will be followed until all study assessments have been completed, an expected average 4 weeks.	4 Paradigms: 1. Resting 2. Tactile Touch 3. Motor 4. Auditory

Secondary Outcome Measures

Name	Time	Method
Neurological Examination	Participants will be followed until all study assessments have been completed, an expected average 4 weeks.
Serum Ammonia Level	Participants will be followed until all study assessments have been completed, an expected average 4 weeks.	Hepatic Encephalopathy Group only
Neuropsychological Testing	Participants will be followed until all study assessments have been completed, an expected average 4 weeks.	WAIS-III PHES Digit Span and Trails
EEG Testing	Participants will be followed until all study assessments have been completed, an expected average 4 weeks.

Recruitment & Eligibility