Re: ?? for

[Guest guest]

Hi ;

I read this paper a couple of years ago:

Gut. 2004 Apr;53(4):587-92.

Comment in: Gut. 2004 Apr;53(4):475-7.

Fatigue and primary biliary cirrhosis: association of globus pallidus

magnetisation transfer ratio measurements with fatigue severity and

blood manganese levels.

Forton DM, Patel N, Prince M, Oatridge A, Hamilton G, Goldblatt J,

Allsop JM, Hajnal JV, HC, Bassendine M, DE, -

SD

Liver Unit, Faculty of Medicine, St 's Hospital Campus, Imperial

College London, London, UK. d.forton@...

BACKGROUND AND AIM: Fatigue is the commonest symptom in primary

biliary cirrhosis (PBC), affecting individuals at all stages of

disease. The pathogenesis of fatigue in PBC is unknown although rat

models suggest a central nervous system (CNS) cause. We examined the

hypothesis that a CNS abnormality related to cholestasis, rather than

cirrhosis per se, underlies this symptom. PATIENTS AND METHODS:

Fourteen patients with precirrhotic PBC (stage I-II disease), four

patients with stage III-IV PBC, and 11 healthy women were studied

using cerebral magnetisation contrast imaging and proton magnetic

resonance spectroscopy (MRS). RESULTS: The globus pallidus

magnetisation transfer ratio (MTR), a quantifiable tissue

characteristic that may be abnormal in the presence of normal

magnetic resonance imaging, was significantly reduced in precirrhotic

PBC patients compared with healthy controls. These measurements

correlated with blood manganese levels and were more abnormal in the

more fatigued subjects. There were no differences in MRS measurements

between the three study groups, suggesting that the abnormal MTR was

not related to hepatic encephalopathy. CONCLUSION: This study

suggests that impairments in liver function in PBC may adversely

affect the brain long before the development of cirrhosis and hepatic

encephalopathy, possibly as a result of altered manganese homeostasis

within the CNS. PMID: 15016756.

Full text available at:

http://gut.bmj.com/cgi/content/full/53/4/587

See also the commentary at:

http://gut.bmj.com/cgi/content/full/53/4/475

I now wonder whether if this occurred in children might it cause not

only fatigue but also other behavioral changes? Has Noah been tested

for elevated serum manganese?

Best regards,

Dave R.

[Guest guest]

Thanks

for your help, it is greatly appreciated. I was getting so frustrated, couldn’t

find anything! Doesn’t seem

to be much research on pediatric HE, you’d think there would be a bunch

and certainly more current news. I

wonder why there isn’t more.

Thanks again , at least now has something to take to the doctor.

Barb in Texas

[Guest guest]

No, no serum manganese. I looked through all his lab results. Very

interesting to me though. The pulmonologist brought up ferritin

levels. I thought that was interesting since iron is an issue and

lucky me...I had his life of labs right there and he has had low

ferritin...but high iron...so she said you could not really supplement.

Just thought I would throw that one out there as another hypothesis

that was thought about.

It's all very interesting. I know iron can be stored in high

quantities with some liver diseases if I recall, so it was curious to

me that ferritin was on her list of concerns.