J Mov Disord.  2016 May;9(2):104-113. 10.14802/jmd.15047.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

  • 1Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand. kmmdsresearch@gmail.com
  • 2Department of Preventive and Community Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand.
  • 3Epidemiology Division, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.


The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes.
Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders.
The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor.
The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.


Cirrhosis; Hepatic encephalopathy; Bradykinesia; Parkinsonism; Intention tremor; Jerky pursuit
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