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P64 Central nervous system involvement in patients with chronic hepatitis C virus infection and minimal liver disease
  1. E Williams1,
  2. M Heeren2,
  3. C D Jackson3,
  4. H Pflugrad2,
  5. J Krause2,
  6. L M Weber2,
  7. K Wiessenborn2,
  8. M Y Morgan1
  1. 1Centre for Hepatology, UCL Medical School
  2. 2Department of Neurology, Medizinische Hochschule Hannover, Germany
  3. 3Department of Neurophysiology, Royal Free Hampstead NHS Trust, London, UK


Introduction Individuals with chronic HCV infection are frequently fatigued and have difficulties with tasks of complex attention, visual scanning and psychomotor speed, even in the absence of significant liver injury. However, the objectivity of these findings has been questioned. Observed alterations in neurometabolite concentrations on cerebral 1H-MRS further supports evidence of CNS involvement. These changes in cognition and 1H-MRS seem to persist despite successful anti-viral therapy but this has not been studied systematically. No information is currently available on possible EEG changes in this population which, if present, might provide an easily available objective marker of CNS involvement.

Aim The aim of this study was to characterise the EEG in HCV-infected patients with minimal liver injury in relation to treatment status and treatment responses.

Method The study population comprised 114 HCV-infected individuals (75 women: 39 men) of mean (range) age 52.0 (25–75) years with little or no liver disease; the majority of patients had been infected by contaminated blood or blood products; none was misusing alcohol nor on treatment with interferon or psychoactive medication at the time of the study. All patients underwent formal assessment of fatigue, depression and anxiety and extensive psychometric testing. EEGs were recorded on the same day as the neuropsychometric assessment; reference data were obtained from 137 age/gender-matched healthy controls. The EEG was defined as ‘fast’ if the relative β power was >30% on the P3-P4 derivation.

Results The prevalence of fast EEG activity was significantly greater in the patients than controls 43% vs 15% (p<0.0001). Significant correlations were observed between the presence of fast EEG activity and impairments in specific psychometric tests but not with fatigue, depression or anxiety. These abnormalities were observed independently of HCV-RNA levels and treatment status (Abstract P64 table 1):

Abstract P64 Table 1

Conclusion Patients with HCV infection with little or no evidence of liver injury show impaired cognitive function and an excess of fast EEG activity independent of fatigue, depression and anxiety. These findings hold true even if the patients have cleared the virus, either spontaneously or following anti-viral treatment. These results could be indicative of an effect of cerebral HCV-quasispecies similar to that suggested in HIV-associated dementia.

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