NEUROLOGICAL MANIFESTATIONS OF PRIMARY CHOLESTATIC LIVER DISEASES

Abstract

The most typical and early signs of primary cholestatic liver diseases are represented by itching, prominent asthenia and autonomic dysfunction. These abnormalities significantly affect the quality of life. The data obtained relate itching and asthenic syndrome in cholestatic liver diseases to pathological changes of the central nervous system (CNS). The special scales for assessment of severity of asthenic manifestations, itching and quality of life in primary biliary cholangitis were developed. Besides, memory defects and loss of concentration ability are quite often seen even in non-cirrhotic patients. These defects have a tendency to progress without obvious associations with biochemical and histological parameters of liver disease severity. Some investigators underline the association of asthenic and cognitive disorders with autonomic dysfunction, systolic hypotension and impaired brain perfusion. The origin of itching in cholestatic liver diseases is largely attributed to central nociceptive sensitization and an increased tone of endogenous opiate system. Pathogenetic mechanisms of CNS dysfunction in non-cirrhotic patients with cholestatic diseases may involve neuroinflammation, hypovitaminosis D and E, influence of secondary hyperparathyroidism and exсessive bile acids concentration in blood.