TY - JOUR T1 - Neuropsychiatric performance and treatment of hepatitis C with direct-acting antivirals: a prospective study JF - BMJ Open Gastroenterology DO - 10.1136/bmjgast-2017-000183 VL - 4 IS - 1 SP - e000183 AU - Sofia Volpato AU - Sara Montagnese AU - Alberto Zanetto AU - Matteo Turco AU - Michele De Rui AU - Alberto Ferrarese AU - Piero Amodio AU - Giacomo Germani AU - Marco Senzolo AU - Martina Gambato AU - Francesco Paolo Russo AU - Patrizia Burra Y1 - 2017/12/01 UR - http://bmjopengastro.bmj.com//content/4/1/e000183.abstract N2 - Background Since direct-acting antivirals (DAAs) have been approved for the treatment of hepatitis C virus (HCV) infection, a small series of patients with new-onset neuropsychiatric alterations have been referred to us. We therefore set out to study neuropsychiatric function in relation to DAAs prospectively.Methods Ten patients with cirrhosis and 12 post-liver transplant (post-LT) patients were enrolled. All underwent wake electroencephalography (EEG) and a neuropsychological evaluation (paper and pencil battery, simple/choice reaction times, working memory task) at baseline, at the end of treatment with DAAs and after 6 months. At the same time points, full blood count, liver/kidney function tests, quantitative HCV RNA, ammonia and immunosuppressant drug levels were obtained, as appropriate.Results Patients with cirrhosis were significantly older than post-LT patients (65±12 vs 55±7 years; P<0.05). Neuropsychological performance and wake EEG were comparable in the two groups at baseline. At the end of a course of treatment with DAAs, a significant slowing in choice reaction times and in the EEG (increased relative delta power) was observed in patients with cirrhosis, which resolved after 6 months. In contrast, no significant changes over time were observed in the neuropsychiatric performance of post-LT patients. No significant associations were observed between neuropsychiatric performance and stand-alone/combined laboratory variables.Conclusion Some degree of neuropsychiatric impairment was observed in relation to treatment with DAAs in patients with cirrhosis, but not in post-LT patients, suggesting that the former may be sensitive to mild DAA neurotoxicity. ER -