 A new classification has been recently proposed called the SONIC classification 7. This was necessary because the differentiation between minimal and Grade I HE is not reliable, but there is good inter-rater reproducibility in the identification of Grade II HE. It was suggested that patients with minimal HE and Grade I HE should be grouped together. It stresses that worsening cognitive function is continuum rather than categorical as emphasized in the Vienna 11th World Congress. It classifies patients with cirrhosis as being unimpaired and impaired neurocognitive function. Impaired cognitive function is subdivided into Covert HE Minimal HE and Grade I HE and Overt HE Grades II-IV. It is thus inclusive of the West Haven criteria, yet emphasizes continuity as opposed to being categorical. The neurocognitive function of impaired, unstable patients can fluctuate from acute confusional syndrome to coma Grades I to IV. They are the so called Type C- episodic HE patients. 