Peripheral Neuropathy and Restless Legs Syndrome in Cirrhosis: An Electrophysiological Cross-sectional Study

Peripheral neuropathy (PN) and restless leg syndrome (RLS) are common in patients with cirrhosis. We report the PN profile in cirrhosis, with or without RLS.

This cross-sectional study included nondiabetic adults (aged ≥18 years) with cirrhosis who were screened for RLS. Participants with recent (<4 weeks) deterioration of liver disease, hemodynamic instability, overt neuropathy, neurological illness, pregnancy, chronic kidney disease, using psychotropic drugs, or uncontrolled systemic illness were excluded. RLS was diagnosed according to standard criteria. Nerve conduction studies (NCS) were performed and evaluated using a Keypoint workstation (Dantec, Skovlunde, Denmark) with a standard protocol for all participants. Motor NCS were recorded in the median, ulnar, and common peroneal nerves (CPN). Sensory NCS were performed with antidromic technique on median, ulnar, and sural nerves. PNs were grouped as demyelinating/axonal/combined and motor/sensory/combined. Numerical and categorical variables were summarized as median (interquartile range) and proportions (percentage), respectively.

Among 97 patients (69.1% male; age 52 [44-60] years; Child-Pugh-Turcotte [CTP]-A/B/C 46.4%/47.4%/6.2%), 27.8% had RLS. PN was present in 53.6% (65.4% motor, 13.5% sensory, and 21.1% combined). The incidence of PN in CTP-A/B/C was 57.8%/50%/50% (p = 0.75). PN was present in 48.2% of patients with RLS and 55.7% of those without RLS (p = 0.50). The distribution of demyelinating/axonal/combined neuropathies, as well as motor/sensory/combined neuropathy, was comparable between those with and without RLS.

PN is frequently detected in patients with cirrhosis. Motor involvement was commner than sensory neuropathy. In this cohort, the presence of PN or its type was not associated with RLS.