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Alcoholic Neuropathy

Alcoholic neuropathy is a neurological disorder induced by long-term alcohol abuse. It is primarily associated with sensory alterations, but may also be characterized by weakness and pain.


Presentation

AN is related to chronic alcohol abuse, and the disease follows a slowly progressive course. Superficial sensory alterations are noted first and dominate the clinical picture throughout the disease [6]. Patients typically claim intense, burning pain in the lower limbs. Both hyperalgesia and allodynia have been reported. As the disease progresses, the arms become involved while sensory deficits and weakness set in [5]. Due to reduced sensations in arms and legs, AN patients are prone to injuries. Affected individuals frequently describe paresthesias, which are initially noted in hands and feet, but that subsequently progress towards proximal portions of the extremities. An unsteady gait and walking disabilities may be observed in advanced stages of the disease. In AN patients, muscle strength is largely unaltered [7].

Asymptomatic
  • The disorder was often clinically asymptomatic and demonstrable only on electroneurographic investigation.[dx.doi.org]
  • Some cases are seemingly asymptomatic and may only be recognized on careful examination. The most severe cases may cause profound physical disability.[en.wikipedia.org]
Plethora
  • The finding of a strong correlation between polyneuropathy and the presence of liver disease and macrocytosis confirms yet again the plethora of diseases related to alcohol misuse. Table 1.[dx.doi.org]
Numbness of the Feet
  • You might not feel temperature changes or pain on parts of your body that are numb. Infection . Your feet and other areas lacking sensation can become injured without your knowing.[mayoclinic.org]
Peripheral Neuropathy
  • We suggest that a defect in thiamine utilization is involved in peripheral neuropathy of alcoholics, rather than a lack of thiamine itself.[ncbi.nlm.nih.gov]
  • The present review is focused around the multiple pathways involved in the development of peripheral neuropathy associated with chronic alcohol intake and the different therapeutic agents which may find a place in the therapeutic armamentarium for both[ncbi.nlm.nih.gov]
  • Another form of peripheral neuropathy is caused by exposure to toxins, such as pesticides and heavy metals, and is equally detrimental to health. People who have undergone chemotherapy can experience peripheral neuropathy as well.[texasfootdoctor.org]
  • A person with this condition is at the same risk, and should take the same precautions as people with diabetic peripheral neuropathy.[firstcoastfootclinic.com]
Foot Drop
  • Foot braces may also be helpful if you have problems with foot drop. If you have weakness in your arms, a wrist splint may be helpful. A physiotherapist may be the best person to help you with such aids.[patient.info]

Workup

The diagnosis of AN is based on a prior diagnosis of alcoholism which, in turn, relies on anamnestic data provided by the patient and third parties [8]. Although electrophysiological studies may be conducted to confirm a clinical diagnosis of polyneuropathy, findings such as decreased amplitudes of sensory potentials and mild to moderate reductions of nerve conduction velocities are not specific for AN [4].

Patients suffering from chronic alcoholism frequently present comorbidities such as alcoholic hepatitis, cardiomyopathy, and nutrient deficiencies. Workup should thus include studies to assess the condition of the respective organ systems and the patient's nutritional status. In this context, it should be noted that long-term alcohol abuse is associated with thiamine deficiency and possibly Wernicke-Korsakoff syndrome, a brain disorder. Even if thiamine deficiency is not a prerequisite for AN, it may modify the patient's clinical presentation [6] [9].

In detail, the following diagnostic measures may be undertaken [10]:

  • Laboratory analyses of blood samples, paying particular attention to liver enzyme levels (γ-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, ratio aspartate aminotransferase/alanine aminotransferase), carbohydrate deficient transferrin, markers of cardiac involvement (NT-proBNP, troponins, creatine kinase-MB), nutrient concentrations (thiamine, vitamin B12) and erythrocyte counts
  • Assessment of fasting glucose levels and glucose tolerance to rule out diabetic neuropathy
  • Imaging studies focusing on liver and brain
  • Electrocardiography, echocardiography

Treatment

  • Treatment Options For Alcoholic Neuropathy The effectiveness of treatment regimes will vary from one person to another. The longer a person has been drinking heavily the less effective the treatments may be.[learn-about-alcoholism.com]
  • Thus, oral MX therapy can be a reliable treatment for pain in alcoholic neuropathy.[ncbi.nlm.nih.gov]
  • Treatment of diabetic neuropathy (polyneuropathy) and alcoholic polyneuritis Treatment of diabetic and alcoholic neuropathy (polyneuropathy, polyneuritis) chosen individually in each case.[minclinic.ru]
  • Treatment of alcoholic neuropathy Nerve damage that results from alcoholic neuropathy is usually permanent, but the symptoms can be treated.[summerlinfootandankle.com]

Prognosis

  • Heavy drinking seems to worsen the prognosis of these neuropathies.[ncbi.nlm.nih.gov]
  • Prognosis of alcoholic peripheral neuropathy. Abstract Ten male alcoholics aged 38-72 years with clear clinical and electroneurographical signs of peripheral neuropathy were re-examined three to five years later.[jnnp.bmj.com]
  • What is the prognosis? The prognosis for a patient facing alcohol-related neuropathy is challenging to assess due to complications of addiction and alcoholism.[painhq.org]
  • Despite the patient's poor prognosis and continued deterioration, he underwent a liver transplant in December 1999. Following the transplant, he noticed progressive recovery of strength in both legs.[news-medical.net]

Etiology

  • The present study confirms the significant role of alcohol abuse in etiology of peripheral neuropathies. Heavy drinking seems to worsen the prognosis of these neuropathies.[ncbi.nlm.nih.gov]
  • The lack of specific diagnostic criteria for alcoholic polyneuropathy requires that other potential etiologies be excluded before that diagnosis is made.[ncbi.nlm.nih.gov]
  • (Etiology) The exact cause of Alcoholic Neuropathy is unclear.[dovemed.com]

Epidemiology

  • Hedberg , Alcohol Consumption and Complaints from the Musculoskeletal System among Engine Drivers—an Epidemiological Study , Scandinavian Journal of Social Medicine , 16 , 2 , (105) , (1988) . E. Dahme, W. Kraft and J.[doi.org]
  • The marked prevalence of males in our sample (70.6 vs 29.4%) agrees with epidemiological studies indicating that alcoholism prevails in men ( Indagine Nazionale DOXA, 1998 ; GESIA, 1999 ).[dx.doi.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of alcoholic polyneuropathy is an area of current research.[en.wikipedia.org]
  • The pathophysiological mechanisms of polyneuropathy in patients with chronic alcohol abuse are still a matter of debate.[jamanetwork.com]
  • J. ( 1986 ) Alcoholic organic brain disease: nosology and pathophysiologic mechanism. Progress in Neuro-psychopharmacology and Biological Psychiatry 10 , 147 –164.[dx.doi.org]

Prevention

  • […] must be stopped to prevent the damage from getting worse.[stlukes-stl.com]
  • It is key to treat this condition immediately to prevent any further damage.[quitalcohol.com]

Summary

Long-term, excessive consumption of alcoholic beverages is known to adversely affect distinct organ systems. Chronic alcoholism may cause alcoholic hepatitis and cirrhosis, arrhythmias and alcoholic cardiomyopathy, alcoholic neuropathy (AN) and epilepsy [1]. A causal relation between alcohol abuse and hypertension has repeatedly been suggested but has recently been questioned [2] [3].

AN is a neurological, potentially reversible disorder affecting the peripheral nervous system. Histopathological analyses of biopsy specimens obtained from AN patients reveal an overall reduced nerve fiber density as well as axonal degeneration with diminished axonal sprouting [4]. The clinical equivalents of these lesions are a pain, increased sensitivity to pain, dysesthesias, and weakness. Abstinence is the mainstay of treatment, but patients may benefit from supportive measures such as physical and occupational therapy as well as dietary supplementation [5].

References

Article

  1. Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs. 2003;17(14):1013-1030.
  2. Grogan JR, Kochar MS. Alcohol and hypertension. Arch Fam Med. 1994;3(2):150-154.
  3. Lip GY, Beevers DG. Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and hypertension--does it matter? (no!). J Cardiovasc Risk. 2003;10(1):11-14.
  4. Maiya RP, Messing RO. Peripheral systems: neuropathy. Handb Clin Neurol. 2014;125:513-525.
  5. Chopra K, Tiwari V. Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012;73(3):348-362.
  6. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. 2006; 19(5):481-486.
  7. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful peripheral neuropathies. Curr Neuropharmacol. 2006;4(3):175-181.
  8. Madden JS. The definition of alcoholism. Alcohol Alcohol. 1993;28(6):617-620.
  9. Mellion M, Gilchrist JM, de la Monte S. Alcohol-related peripheral neuropathy: nutritional, toxic, or both? Muscle Nerve. 2011;43(3):309-316.
  10. Maisch B. Alcoholic cardiomyopathy : The result of dosage and individual predisposition. Herz. 2016;41(6):484-493.

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Last updated: 2018-06-22 02:46