Cognitive Dysfunction in Children with Chronic Liver Diseases and Portal Vein Thrombosis

MOHAMMED A.E. EL-GUINDI, M.D.*; MAGDY A. SABER, M.D.*; NAHLA M.S. ABDELHADY, M.D.**;, MOHAMED G. HENIDY, M.Sc.*** And OLA A. FOUAD, M.D.*

doi:10.21608/mjcu.2024.371363

Cognitive Dysfunction in Children with Chronic Liver Diseases and Portal Vein Thrombosis

Document Type : Original Article

Author

MOHAMED G. HENIDY, M.Sc.*** and OLA A. FOUAD, M.D.* MOHAMMED A.E. EL-GUINDI, M.D.*; MAGDY A. SABER, M.D.*; NAHLA M.S. ABDELHADY, M.D.**;

The Department of Pediatric Hepatology, Gastroenterology & Nutrition*, National Liver Institute, Menoufia University, Department of Pediatric, Neurology Unit**, Faculty of Medicine, Menoufia University and Pediatric Department, Ministry of Health, Kafr EL-Sheikh, Egypt***

10.21608/mjcu.2024.371363

Abstract

Background: Chronic liver diseases (CLD) are a common cause of morbidity and mortality in children. Neurologic affec-tion in CLD may be due to brain accumulation of ammonia and lactate; altered permeability of the blood-brain barrier and neu-roinflammation. Chronic portal vein thrombosis (PVT), with a development of Porto-systemic shunts through which several neurotoxins can pass to the systemic circulation, may affect the neurocognitive functions. Aim of Study: The aim of this study was to assess and manage the cognitive dysfunction in children with CLD and in those with chronic PVT. Patients and Methods: The study was a cross sectional one that included 150 children, recruited over a period of three years (August, 2020 – August, 2022), who were categorized into three groups, group 1 included 60 patients with CLD, group 2 included 30 patients with chronic PVT and group 3 which in-cluded 60 apparently healthyage matched children. All children underwent assessment of the cognitive performance using the Arabic Version of the Revised Wechsler Intelligence Scale for Children (WISC-IV) followed by treatment of patients showed cognitive dysfunction by either lactulose or rifaximin for three months duration. The cognitive performance of affected chil-dren was reassessed after the end of treatment. Results: 98.3% of the healthy control group had normal in-telligence versus 70% of PVT group and 63.3% among those with CLD. The presence of CLD significantly increases the risk of below normal intelligence scale by 34.16 folds while PVT significantly increases that risk by 25.29 folds. After treatment with lactulose, the cognitive performance of 50% of CLD pa-tients and 66.7% of PVT patients have been improved with a statistically significant difference (p-value=0.011 and p-value =0.034 respectively). While after treatment with rifaximin, the cognitive performance of 16.7% of CLD group have been im-proved with non-significant (p-value=0.317). Conclusion: Chronic liver diseases and PVT in children significantly increase the risk of cognitive dysfunction which can be improved with lactulose.

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