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Metab Brain Dis (2011) 26:281289 DOI 10.1007/s11011-011-9260-z
ORIGINAL PAPER
Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial
Michele Malaguarnera & Marco Vacante & Massimo Motta & Maria Giordano &
Giulia Malaguarnera & Rita Bella & Giuseppe Nunnari & Liborio Rampello &
Giovanni Pennisi
Received: 5 June 2011 /Accepted: 11 August 2011 /Published online: 26 August 2011 # Springer Science+Business Media, LLC 2011
Abstract The aim of this study was to investigate the effects of ALC treatment on cognitive functions in patients with severe hepatic encephalopathy. This was a randomized, double-blind, placebo-controlled study. 61 patients with severe hepatic encephalopathy were recruited to the study. The 2 groups received either 2 g ALC twice a day (n=30) or placebo (n=30) for 90 days. Clinical and laboratory assessment, psychometric tests and automated electroencephalogram (EEG) analysis were performed for all patients. At the end of the study period, between the 2 groups we observed a significant difference in Everyday Memory Questionnaire 23.9 vs 4.4 (p<0.001), Logical Memory (Paragraph recall) test 22.3 vs 0.7 (p<0.001), Trail Making Test A 7.5 vs 2.6 (p<0.001), Trail Making Test B 10.5 vs 3.1 (p<0.001), Controlled Oral Word Association Test 4.2 vs 0.5 (p<0.001), Hooper test 2.6 vs 0.1 (p<0.05), Judgement of line orientation 2.8 vs 0.3 (p<0.001), Digit Cancellation time 24.5 vs 2.4 (p<0.001), NH4+ 30.5 vs13.5 (p<0.001), prothrombin time 2 vs 2.4 (p<0.05), alanine transaminase 10.7 vs 13.6 (p<0.001). 88% of
patients treated with ALC vs 72% of patients treated with placebo showed a significant improvement in EEG. The improvement of cognitive deficits, the reduction of ammonia, and the modification of EEG in patients treated with ALC suggest that ALC could represent a new tool in the treatment of severe hepatic encephalopathy.
Keywords Acetyl-L-carnitine . L-carnitine . Severe hepatic encephalopathy. Cognitive functions
Introduction
Hepatic encephalopathy (HE) is a reversible state of impaired cognitive function or altered consciousness which occurs in subjects with liver disease or portal systemic shunts (Voigt and Conn 1995). The severe HE may progress within a matter of hours from a mild confusional state to deep coma. Severe HE (grade 3 of the West Haven grading scale) is characterized by severe disorders of consciousness, intellectual function, personal and behaviour and neuro-muscular abnormalities (Table...