Alcoholic polyneuropathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Alcoholic polyneuropathy is a disease that develops in persons suffering from chronic alcoholism, which is based on multiple lesions of the peripheral nervous system.
The prevalence of pathology among people who abuse alcohol for a long time, according to some data, in the Russian Federation reaches 60–90%. According to the results of Western epidemiological studies, in the United States, alcoholic polyneuropathy is found in 25–66% of patients with chronic alcoholism.
Alcoholic neuropathy is characterized by multiple lesions of the peripheral nervous system
The disease is more common in women, develops at an earlier stage of alcoholism and is more severe than in men.
It has been established that daily consumption of 100 ml of anhydrous ethyl alcohol (corresponds to 200-300 ml of strong alcoholic beverage) leads to the development of neuropathy within 3-10 years.
Synonym: alcoholic neuropathy, alcoholic polyneuropathy, alcoholic neuritis.
Causes and risk factors
The main cause of peripheral nerve damage is the direct damaging effect of alcohol and its metabolites on the nervous tissue.
Other reasons:
- violation of microcirculation in the peripheral bed, which supplies the nerve fibers;
- toxic damage to the tissues of the liver and intestines and, as a result, a violation of the metabolism of vitamin B1 (hypovitaminosis B1), which is a regulator of metabolism and plays an important role in the conduction of a nerve impulse in synapses;
- periodic episodes of compression of the nerve trunks due to prolonged stay in one position with intense intoxication and, as a result, developing compression-ischemic changes.
What does a damaged nerve look like in alcoholic polyneuropathy?
The main risk factor for the development of chronic alcoholism - the precursor of alcoholic polyneuropathy - is the hereditary feature of the ALDH1 and ALDH4 genes, which encode the key enzymes for the conversion of ethanol - alcohol and acetaldehydrogenase. With the pathology of these genes, researchers associate the failure of the mechanisms for neutralizing toxic intermediate products of ethyl alcohol and, accordingly, a high risk of developing alcoholism (50%).
Forms of the disease
Acute and subacute forms of the disease are distinguished.
The disease usually develops in a subacute form, progressing over many months or years. Much less common is the acute form of alcoholic polyneuropathy, which develops a few days after taking alcohol in extreme quantities and is characterized by violent symptoms.
Disease stages
There are no clearly defined stages in the development of the disease, nevertheless, some authors distinguish the following stages:
- Initial. The appearance of the first non-specific complaints.
- Progressive. Increased symptoms of the disease.
- Stationary. The stage of the expanded clinical picture.
- Reverse development. Achieved during therapy. The severity of positive dynamics depends on the intensity of the pathological process, an integrated approach to treatment, and the patient's ability to refuse alcohol.
Symptoms
The main signs of alcoholic polyneuropathy:
- feeling of "creeping creeps", tingling or burning in the feet;
- soreness, cramps in the calf and thigh muscles;
- muscle weakness;
- numbness of the limbs;
- chilliness, cold extremities;
- decreased sensitivity of the "socks" and "gloves" type;
- change in gait;
- perversion of perception of stimuli in the limbs;
- puffiness and marble pallor of the skin of the distal extremities;
- slurred speech;
- sweating of palms, feet.
Tingling sensation, burning in the feet, numbness and decreased sensitivity are the main signs of alcoholic polyneuropathy
At the initial stage of the disease, patients present with vaguely formulated complaints of transient muscle pain, numbness, and discomfort. Unpleasant sensations are localized in the distal parts of the limbs (feet, less often the hands). As the progression progresses, the listed symptoms cover the entire limb, signs of disruption of the internal organs appear. In severe cases, mental disorders join, the oculomotor, visual, vagus (less often) nerves are involved in the pathological process.
Diagnostics
The diagnosis of alcoholic polyneuropathy is based on:
- correlating clinical manifestations with a long history of alcohol or acute alcohol intoxication;
- data of an objective examination of the patient (the presence of signs of liver damage, pancreas, skin color, hyperpigmentation, hyperhidrosis and edema);
- neurological status (decrease or loss of tendon reflexes, hypesthesia, decreased muscle strength, muscle hypotension, etc.);
- the results of the study of the level of thiamine in the blood (its decrease);
- the results of instrumental research methods (electromyography, quantitative sensory and autonomous testing, biopsy of nerve fibers).
Treatment
Treatment should be comprehensive (pharmacotherapy in combination with physiotherapy), but its success depends primarily on the cessation of alcohol use.
Drug therapy:
- a diet high in vitamin B1;
- multivitamins, preparations of B vitamins;
- hepatoprotectors;
- drugs that improve peripheral blood flow;
- antioxidant therapy;
- drugs to improve neuromuscular conduction;
- metabolites;
- with severe pain - non-steroidal anti-inflammatory drugs, non-narcotic analgesics;
- if necessary - anxiolytics, tranquilizers.
Physiotherapy methods:
- electrical stimulation;
- magnetotherapy;
- acupuncture;
- electrophoresis;
- therapeutic massage and physical education.
Possible complications and consequences
Possible complications of alcoholic polyneuropathy are:
- acute heart failure;
- acute renal failure;
- acute liver failure;
- dysfunction of the pelvic organs;
- decreased or loss of vision;
- cerebellar degeneration;
- mental disorders;
- epileptiform disorders;
- alcoholic dementia;
- muscle atony;
- paralysis, paresis;
- loss of sensation in the limbs.
Alcoholic polyneuropathy leads to many complications
Forecast
With timely treatment, the reverse development of the disease is possible, and the patient's quality of life can improve. A necessary condition for a favorable prognosis is a complete rejection of alcohol consumption.
In most cases, patients are disabled, acquiring one or another degree of disability, since early access to a specialist in this case is a rare occurrence. An important factor determining the unfavorable prognosis is the inability of the patient to refuse alcohol and to observe a long-term therapeutic and protective regime.
Prevention
The main preventive measure is avoiding alcohol abuse.
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
