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Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial

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Abstract

The aim of this study was to investigate the effects of ALC treatment on cognitive functions in patients with severe hepatic encephalopathy. This was a randomized, double-blind, placebo-controlled study. 61 patients with severe hepatic encephalopathy were recruited to the study. The 2 groups received either 2 g ALC twice a day (n = 30) or placebo (n = 30) for 90 days. Clinical and laboratory assessment, psychometric tests and automated electroencephalogram (EEG) analysis were performed for all patients. At the end of the study period, between the 2 groups we observed a significant difference in Everyday Memory Questionnaire −23.9 vs 4.4 (p < 0.001), Logical Memory (Paragraph recall) test 22.3 vs 0.7 (p < 0.001), Trail Making Test A −7.5 vs −2.6 (p < 0.001), Trail Making Test B −10.5 vs −3.1 (p < 0.001), Controlled Oral Word Association Test 4.2 vs 0.5 (p < 0.001), Hooper test 2.6 vs 0.1 (p < 0.05), Judgement of line orientation 2.8 vs 0.3 (p < 0.001), Digit Cancellation time −24.5 vs −2.4 (p < 0.001), NH +4 30.5 vs 13.5 (p < 0.001), prothrombin time 2 vs 2.4 (p < 0.05), alanine transaminase −10.7 vs −13.6 (p < 0.001). 88% of patients treated with ALC vs 72% of patients treated with placebo showed a significant improvement in EEG. The improvement of cognitive deficits, the reduction of ammonia, and the modification of EEG in patients treated with ALC suggest that ALC could represent a new tool in the treatment of severe hepatic encephalopathy.

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Conflicts of interest

The authors disclose no conflicts.

Funding

This clinical trial was supported by a grant from MURST (Ministero dell’Università e Ricerca Scientifica e Tecnologica).

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Authors and Affiliations

  1. Research Center “The Great Senescence”, University of Catania, Ospedale Cannizzaro, Viale Messina, 829 – 95125, Catania, Italy

    Michele Malaguarnera, Marco Vacante, Massimo Motta & Maria Giordano

  2. Department of Neurosciences, University of Catania, Catania, Italy

    Giulia Malaguarnera, Rita Bella, Liborio Rampello & Giovanni Pennisi

  3. Department of Infectious Diseases, University of Catania, Catania, Italy

    Giuseppe Nunnari

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  1. Michele Malaguarnera
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  2. Marco Vacante
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  3. Massimo Motta
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  4. Maria Giordano
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  5. Giulia Malaguarnera
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  6. Rita Bella
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  9. Giovanni Pennisi
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Correspondence to Michele Malaguarnera.

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Malaguarnera, M., Vacante, M., Motta, M. et al. Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial. Metab Brain Dis 26, 281–289 (2011). https://doi.org/10.1007/s11011-011-9260-z

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  • DOI: https://doi.org/10.1007/s11011-011-9260-z

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