Asterixis is a neurological disorder that causes a person to lose motor control of certain areas of the body. Muscles — often in the wrists and fingers, although it can happen in other areas of the body — can abruptly and intermittently become lax.

This loss of muscle control is also accompanied by irregular and involuntary jerking movements. For that reason, asterixis is sometimes called “flapping tremor.” Since certain liver diseases seem linked to asterixis, it’s sometimes called “liver flap” as well. The flapping is said to resemble a bird’s wings in flight.

According to research, these wrist-hand “tremors” or “flapping” motions are most likely to occur when the arms are outstretched and wrists are flexed. Asterixis on both sides of the body is far more common than unilateral (one-sided) asterixis.

The condition was first recognized nearly 80 years ago, but a lot still remains unknown about it. The disorder is thought to be caused by a malfunction in the part of the brain that controls muscle movement and posture.

Why that malfunction occurs isn’t entirely known. Researchers suspect there may be certain triggers, which include encephalopathies.

Encephalopathies are disorders that affect brain function. Symptoms include:

Some types of encephalopathy that can result in asterixis are:

  • Hepatic encephalopathy. Hepatic refers to the liver. The liver’s main function is to filter toxins from the body. But when the liver is impaired for any reason, it may not remove toxins efficiently. Consequently, they can build up in the blood and enter the brain, where they disrupt brain function.
  • Metabolic encephalopathy. A complication of liver and kidney disease is metabolic encephalopathy. This occurs when too much or too little of certain vitamins or minerals, such as ammonia, cross the blood-brain barrier, causing neurological misfirings.
  • Drug encephalopathy. Certain medications, such as anticonvulsants (used to treat epilepsy) and barbiturates (used for sedation), can affect brain responses.
  • Cardiac encephalopathy. When the heart doesn’t pump enough oxygen throughout the body, the brain is affected.

Pretty much anything that affects brain function can lead to asterixis. This includes:


A stroke occurs when blood flow to a part of the brain is restricted. This can happen because of a blood clot blocking an artery or because of a narrowing of the arteries due to things like smoking or high blood pressure.

Liver disease

Liver diseases that put you at high risk of asterixis include cirrhosis or hepatitis. Both these conditions can cause scarring of the liver. This makes it less efficient at filtering out toxins.

According to research, up to 45 percent of people with cirrhosis have hepatic (liver) encephalopathy, which puts them at greater risk for asterixis.

Kidney failure

Like the liver, the kidneys also remove toxic materials from the blood. If too many of these toxins are allowed to build up, they can alter brain function and lead to asterixis.

The kidneys and their ability to do their job can be damaged by conditions like:

  • diabetes
  • high blood pressure
  • lupus
  • certain genetic disorders

Wilson’s disease

In Wilson’s disease, the liver doesn’t adequately process the mineral copper. If left untreated and allowed to build up, copper can damage the brain. This is a rare, genetic disorder.

Experts estimate about 1 in 30,000 people have Wilson’s disease. It’s present at birth but may not become apparent until adulthood. Symptoms of toxic copper levels include:

  • asterixis
  • muscle stiffness
  • personality changes

Other risk factors

Both epilepsy and heart failure are also risk factors for asterixis.

A diagnosis of asterixis is often based on both a physical exam and lab tests. Your doctor may ask you to hold your arms out, flex your wrists, and spread your fingers. After a few seconds, a person with asterixis will involuntarily “flap” the wrists downward, then back up. Your doctor may also push against the wrists to prompt the response.

Your doctor may also order blood tests that look for buildups of chemicals or minerals in the blood. Imaging tests, such as CT scans, can examine brain function and visualize areas that may be affected.

When the underlying condition causing asterixis is treated, asterixis generally improves and even goes away entirely.

Encephalopathies of the liver or kidney

Your doctor may recommend:

  • Lifestyle and dietary changes. If you’re misusing alcohol or have a kidney-damaging condition like diabetes, your doctor can talk to you about reducing your health risks.
  • Laxatives. Lactulose in particular can speed the removal of toxins from the body.
  • Antibiotics. These drugs, like rifaximin, reduce your gut bacteria. Excessive gut bacteria can cause too much of the waste product ammonia to build up in your blood and alter brain function.
  • Transplants. In severe cases of liver or kidney damage, you may need a transplant with a healthy organ.

Metabolic encephalopathy

Your doctor will likely advise dietary changes, taking drugs that will bind to the mineral to help remove it from the body, or both. It will depend on which mineral is overabundant in your bloodstream.

Drug encephalopathy

Your doctor may change the dosage of a medication or switch you to an entirely different drug.

Cardiac encephalopathy

Getting any underlying heart conditions under control is the first step. That may mean one or a combination of the following:

Your doctor may also prescribe ACE inhibitors, which widen arteries, and beta-blockers, which slow the heartbeat.

Wilson’s disease

Your doctor may prescribe drugs such as zinc acetate, which prevents the body from absorbing copper in the food you eat. They may also prescribe chelating agents like penicillamine. It can help excrete copper out of tissues.

Asterixis isn’t common, but it’s a symptom of a serious and possibly advanced underlying disorder that needs immediate medical attention.

In fact, one study reported that 56 percent of those who presented with asterixis in relation to alcoholic liver disease died, compared to 26 percent of those who didn’t have it.

If you’ve noticed any of the flapping tremors characteristic of asterixis or you have any of the above noted risk factors, speak to your doctor. In many cases, when the condition causing asterixis is successfully treated, asterixis improves or even disappears.