To the Editor.
—I read with interest the report by Nakano et al,1 in the January issue of the Archives, on hepatic ultrastructural change and liver dysfunction in amyotrophic lateral sclerosis. This adds to the list of degenerative disorders of the central nervous system associated with evidence of hepatic dysfunction. Subtle changes in liver function have also been described in Creutzfeldt-Jakob disease2; and hyperammonemia, possibly due to hepatic dysfunction, has been described in Alzheimer's disease.3 Whether the hepatic disturbances are related to the underlying cause of the disease or, rather, are secondary effects related to disease progression, drug toxicity, nutritional inadequacy, or unrelated illness, must await further study.A unitary hypothesis to explain the concurrence of hepatic and central nervous system changes would implicate a common etiopathogenetic agent, eg, a direct effect of the Creutzfeldt-Jakob transmissible agent both on brain and on hepatic function. Similarly, the concurrence
Fisman M. Hepatic Ultrastructural Change and Liver Dysfunction in Amyotrophic Lateral Sclerosis. Arch Neurol. 1987;44(10):997. doi:10.1001/archneur.1987.00520220007005
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