THERAPEUTIC PROTOCOLS AND MANAGEMENT OF NEUROLOGICAL MANIFESTATIONS IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY

Abstract

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome mediated by dysfunction of the gut-liver-brain axis, in which hyperammonemia and intestinal dysbiosis promote neuroinflammation and astrocytic edema. This study conducted a narrative literature review (PubMed, last five years) aiming to analyze therapeutic protocols and the management of neurological manifestations of the condition. The findings confirm lactulose as the cornerstone therapy, while rifaximin — especially in combination therapy — demonstrates superiority in maintaining remission and reducing hospitalizations. Emerging microbiome modulation strategies, such as probiotics and fecal microbiota transplantation, appear promising for restoring intestinal integrity. In neurological management, adjuvant therapies such as L-ornithine L-aspartate (LOLA) and albumin infusion stand out. In pediatrics, monitoring must be rigorous due to the risk of rapid progression to cerebral edema. It is concluded that HE management requires a multidisciplinary and individualized approach focused on reducing nitrogen load and modulating the intestinal environment to optimize prognosis and patients’ quality of life.