Treatment Options For Asterixis

Commonly known as a flapping tremor or a liver flap, asterixis is a neurological symptom. Patients with this symptom suddenly lose muscle control, and it typically affects the wrist and fingers. For example, most patients exhibit a flapping motion of the fingers when they extend their wrist. The flapping occurs on both sides of the body. Asterixis was first identified in the 1940s in patients who had liver disease. Doctors perform a series of neurological tests, checking the hands, fingers, wrists, and arms for weakness and ruling out any other conditions when diagnosing asterixis. Neurologists may also check reflexes, grip strength, coordination, and range of motion. Patients will be asked to extend their hands, flex their wrists, and spread their fingers. Typically, patients with asterixis will experience a tremor after holding this position for a few seconds. The physician may push against the patient's wrists to see if the tremor can be provoked. Occasionally, nerve conduction studies or imaging tests such as CT scans may be needed. Blood tests are often performed to look for an accumulation of certain minerals and chemicals in the bloodstream. Asterixis is associated with several different neurological conditions that can also cause confusion, sleep problems, tremors, and personality changes.Patients with asterixis may benefit from the treatments outlined below.

Liver Or Kidney Transplant

Problems with the liver and kidneys can cause asterixis. For example, patients with liver and kidney disease have impaired function in these organs, resulting in the accumulation of toxins that would normally be flushed out of the body. A disorder known as hepatic encephalopathy results in the accumulation of toxins in the brain, leading to asterixis. In addition, patients with both liver and kidney disease may experience a complication known as metabolic encephalopathy, which can also result in asterixis. Metabolic encephalopathy causes neurological misfiring due to an imbalance of vitamins and minerals that cross into the brain.

A liver or kidney transplant can correct asterixis by giving patients a healthy, functioning organ. Patients must first undergo a series of medical and psychological evaluations before being placed on the transplant list where they can await a donor organ. Transplant surgeries are carried out under general anesthesia, and recovery takes several months. Patients must take anti-rejection medications for the rest of their lives. They also require frequent follow-up appointments for monitoring.

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Dietary Changes

Dietary changes may be beneficial in reducing asterixis, and they are especially useful for patients who have kidney disease or liver disease. Since liver disease is frequently linked to excessive alcohol consumption, one of the major changes doctors recommend is a decrease in consumption. Kidney disease can sometimes develop as a complication of diabetes, and patients can make many dietary changes to reduce their risk of this occurring. Eliminating processed foods, reducing the intake of fast food and fried foods, and increasing intake of fruits and vegetables can all have a positive impact. Choosing to cook meals at home as often as possible is also beneficial. Patients who struggle with diet or who wish to know more about how diet impacts their condition may want to consult a nutritionist with specialist training. These professionals can help patients with proper meal planning and food changes that may reduce unpleasant symptoms.

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Specialized Medication

Since asterixis can be a symptom of many disorders that affect multiple body systems, patients may need specialized medication to control their symptoms. For example, asterixis can be a symptom of Wilson's disease, which causes copper to build up in the brain, liver, and other organs. Wilson's disease patients are typically prescribed zinc acetate to reduce the copper buildup in their body. Chelating medications to remove copper from the body are also typically used. In some instances, asterixis can be caused by cardiac encephalopathy, and these patients need to take medications to help control underlying heart issues. Medications to lower blood pressure may be needed as well.

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Use Of Antibiotics

For some patients, the use of antibiotics can help reduce symptoms of asterixis. One of the most commonly prescribed antibiotics for patients with asterixis is rifaximin, which reduces the bacteria in the stomach. If a patient has too much bacteria in this location, it can cause a dangerous accumulation of ammonia in the body; the ammonia can then enter the brain and lead to cognitive impairment. Rifaximin can cause side effects such as diarrhea, nausea, fever, gas, abdominal pain, bloating, and vomiting. Patients taking this medication should be carefully monitored by their healthcare team, and they should report any concerns or side effects they experience right away.

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Use Of Laxatives

The use of laxatives can help patients excrete toxins from their body and reduce the dangerous buildup of minerals and chemicals. Many different forms of laxatives are available, and some can be purchased over-the-counter. Some patients may use fiber supplements and stool softeners before trying laxatives, and others may need chemical laxatives prescribed by a doctor. One of the most beneficial laxatives for asterixis patients is lactulose, which is available as an oral solution and a rectal solution. It is typically prescribed for patients who have portal-systemic encephalopathy as a result of severe liver disease. It can reduce ammonia levels that are too high. Lactulose may cause side effects such as burping, nausea, gas, and cramps, and in rare cases, severe diarrhea, vomiting, and stomach pain. These patients should inform their healthcare team right away, and they may be instructed to take measures to prevent dehydration. If lactulose is not appropriate for an individual patient, doctors can prescribe other laxatives that may be equally effective.