The Alcoholic neuropathy Is a neurological disease that is characterized by degeneration of the Axons And a decrease in Myelin Of the neuronal fibers that control the sensory system and the motor system (Yerdelen, Koc & Uysal, 2008). This causes an imbalance in the functioning of our nervous system.
That is, the Peripheral nerves Deteriorate due to a Abusive alcohol consumption . It is characterized mainly by strong pains, tremors and sensation of weakness that begins in the extremities (hands and feet) and little by little they are extended to more central parts of the body.
Types of alcoholic neuropathy
It can have several levels of severity, sometimes even the symptoms are difficult to recognize. More serious cases will lead to major physical problems.
It is interesting to note that the Thiamine Gives much more variability to the presentation of alcoholic neuropathy. (Laker, 2015).
What is its prevalence?
In U.S.A. Neuropathy prevails between 22% and 66% of people with chronic alcoholism problems. Obviously, it is more frequent in alcoholics who have consumed more time and who drink more quantity. (Chopra & Tiwari, 2012). For this reason, the majority of diagnosed patients are between 40 and 60 years old. (Laker, 2015)
It appears to be more frequent in women than in men, as manifested in a study by Dina et al. (2007):
"Alcoholic neuropathy appears more rapidly and more severely in female rats than in male rats."
What are the risk factors for developing it?
Alcoholic neuropathy may occur if:
- Alcohol is consumed in large quantities over an extended period of time (approximately 10 years or more).
- There is a lack of thiamine, folate, niacin, vitamins B6, B12 and vitamin E. These nutrients are essential to maintain proper functioning of the nerves and alcohol seems to alter their levels. If consumption stops, these nutrients return to normal, although the damage already produced is permanent. (Allen, 2016)
- Family history of alcoholism.
When it starts?
Alcoholic neuropathy arises gradually, over months or years of excessive alcohol consumption. It is important to know that axonal degeneration usually appears before the first symptoms develop.
In most cases, deterioration begins first in the feet and legs and later in the hands and arms.
Signs and symptoms
Signs and symptoms may vary by person. In most cases it arises slowly and progressively, although some people present an acute and rapid onset. However, it can sometimes be asymptomatic and only recognized with a thorough medical examination.
First the sensory system is damaged and over time the motor system deteriorates, although in rare cases you can notice discomfort of both types at the same time.
As we will see below, these symptoms can be very disabling for those who suffer:
- Unpleasant feeling of tingling, cramping or numbness of extremities ( Paresthesia ), Even in more severe cases pain appears. This pain can vary being sharp and stabbing in some people and in others more mild and constant.
- Absence of sensations coming from the extremities. Patients may not feel where they stand.
- Symmetrical motor alterations (if the disease affects the right foot, it will also affect the left almost simultaneously).
- Intolerance to the heat of the affected areas, being frequent the burning in the feet.
- Decreased fine motor skills.
- Muscular weakness.
- Loss of muscle mass and decrease of deep tendon reflexes.
- Loss of balance, possibly causing possible accidents and fractures.
- Erectile dysfunction in men.
- Frequent colds.
- Dizziness or lightheadedness (Allen, 2016)
- Urinary problems that include: incontinence, false feeling of full bladder and trouble starting to urinate.
- Diarrhea or constipation.
- Decreased weight.
Long-term:
- The damages cover more central parts of the body
- the skin becomes rough and dry (Mehta, 2016).
- Spasms and even atrophy of muscles.
- Although not very frequent, it can get to alter the laryngeal nerve. This is evidenced by alterations in speech, hoarseness and difficulty swallowing (Laker, 2015).
Other symptoms linked to alcoholism may occur in the person with this disease such as liver disease or varicose veins (Brillman, 2005).
Causes
The exact cause of alcoholic neuropathy is still unknown.
Although research indicates that the main cause is probably prolonged alcoholism in addition to malnutrition, it is currently being debated whether substance abuse or nutrient deficiency is more important to the origin of alcoholic neuropathy.
This is understandable, since alcoholics are going to lead a more irregular lifestyle, probably related to bad eating habits.
In addition, alcohol causes a decrease in appetite, as it affects the stomach causing nausea, vomiting and gastritis. It also causes the lining of the digestive system to be altered, decreasing the absorption of nutrients.
This has been observed in studies with rats, in which the neurotoxic effect of Acetaldehyde (A metabolite of ethanol ) Directly in the spinal cord . In addition, ethanol also impairs axonal transport and alters the cytoskeleton of neurons (Laker, 2015).
However, it is not yet known exactly how much alcohol is the one that gives rise to the symptoms (Mehta, 2016).
According to Brillman (2005):
"Many people drink a lot of alcohol for a long time and eat in a balanced way, however, they do not have this disease."
Therefore, we can say that diet plays a fundamental role in the development of alcoholic neuropathy.
Diagnosis
Sometimes, alcoholic neuropathy may be difficult to diagnose because of its similarity to other degenerative polyneuropathies.
To make a safe diagnosis, other diseases must first be ruled out, such as:
- Beriberi (Thiamin deficiency).
- Amyotrophic Lateral Sclerosis.
- Diabetic neuropathy.
- Deficiency of Folate .
- Lack of b12 vitamin .
- Charcot Marie Tooth Disease .
- Diabetic lumbosacral plexopathy.
- Multiple mononeuritis.
- Drug-induced neuropathy (such as Disulfiram ).
First, a detailed history of alcohol consumption, its symptoms and eating habits needs to be obtained from the patient.
The typical findings found on a physical examination of a person suffering from alcoholic neuropathy are as follows:
- Proprioceptive decline.
- Alterations in the thermal sensation.
- Low vibration or puncture sensitivity with"glove and sock"distribution (affection of symmetrical hands and feet).
- Deficiency of muscular reflexes.
- Ankle weakness or dorsiflexion of the toes or ankle.
- In severe cases, atrophy of the intrinsic musculature of the foot.
- Ataxia Of the march and pendular foot.
- Others Damages related to alcohol abuse .
Laboratory tests are recommended to examine:
- Essentially, the levels of thiamine, vitamin B12 and folic acid .
- Enhancement of enzymes in the liver.
- The level of Creatinine (A high level reflects renal failure that can cause peripheral neuropathy).
- Estimate blood sugar levels to rule out the existence of diabetes.
Image studies as:
- Radiography of the affected areas.
- Electromyography (EMG): If there are muscle alterations in the extremities with this test, it is advisable to do it in higher parts of the body to see the extent of the neuropathy.
- Nerve conduction tests and speed of conduction: it can help detect the severity of existing peripheral neuropathy. Conduction velocity is usually normal or slightly slower in patients with alcoholic neuropathy. Slowness increases when neuropathies Demyelinating .
- Vibration capture test: useful for observing the first signs of alcoholic neuropathy.
- Skin biopsy: In one study it was shown that this disease could be diagnosed through a skin biopsy that detected the density of nerve fibers. It was found that nerve fibers are significantly less dense in the group of alcoholic subjects compared to nonalcoholics (Mellion et al., 2004).
These tests can be done to rule out other disorders that give rise to similar symptoms:
- The presence of toxic heavy metals in the blood, causing neuropathy.
- Erythrocyte sedimentation rate : Appears in patients with neuropathy but due to inflammation.
- Test of HIV And venereal diseases: symmetric polyneuropathies may be early manifestations of HIV and syphilis .
Treatments
Currently, the treatments are focused on palliative symptoms and stop the progression of the disease:
- The main thing to stop the development of this disease is to interrupt the consumption of alcohol.
- Take supplements of B vitamins, mainly B12 and thiamine. Folic acid is also recommended.
- ingest the corresponding daily calories (Brillman, 2005).
- Drugs to reduce pain: Gabapentin , Amitriptyline , Or over-the-counter drugs such as aspirin or Acetaminophen .
- Topical cream: it is also recommended the Capsaicin, A natural chemical compound from plants that relieves muscle and joint pain temporarily.
- Ankle and foot orthosis: can help the patient to improve his own ankle awareness, facilitate walking and reduce the likelihood of ankle sprains. Better to wear the right shoes and have the area of the toes more widened. This would prevent ulcers.
Psychological intervention
This intervention should be focused on helping the person to stop drinking. Among the existing strategies are:
- Increased motivation, assuming the advantages of leaving alcohol.
- Set achievable goals to achieve
- Establishment of a commitment with the psychologist to meet the goals established each week.
- Change the habits: at the beginning, you should avoid going to bars and parties. Get away from the"colleagues"with whom he went out drinking.
If you want more information on how to stop alcohol visit The 10 Essential Steps to Quitting Alcohol .
It would be advisable to join a support group to fight alcoholism such as Alcoholics Anonymous (AA).
Comprehensive physical therapy
- Extensive movements exercises, aiming to maintain a normal gait mechanics and prevent contractures.
- Balance and gait training.
- Exercise the weakest muscles.
Nutritional Consultation
Recommended to develop nutritional strategies for the patient to receive the essential nutrients, especially in conditions of malnutrition.
Caution should be exercised with hot foot baths, as it can be dangerous. Keep in mind that these patients may have limbs insensitive and do not perceive burns.
It is very important that periodic visits to health specialists be encouraged to monitor the progression of alcoholic neuropathy. In addition, it is useful to evaluate whether treatments are being effective or whether it is better to make some changes.
It is also essential to educate the patient to develop self-care behaviors. Teach him the negative effects of alcohol consumption on his balance, strength, perception and gait. Also note the importance of proper nutrition.
According to a recent study in rats, it has been shown that pain symptoms produced by alcoholic neuropathy can be improved by co-administration of curcumin and Vitamin E (Kandhare et al., 2012).
Occupational Therapy
- Improve the adaptation of the person to their environment by developing a training in activities of daily living (ADL).
- Transform the person's environment if necessary (adapt the environment in which he lives to reduce his deficits, reduce dangers and maximize his independence)
Surgical intervention
In cases in which there is very serious liver damage, a liver transplant should be considered.
It has been found a case in which the subject recovered from alcoholic neuropathy when performing a liver transplant, in addition to improving their nutritional deficiencies.
Long-term complications
Alcoholic neuropathy if left untreated and maintained for a long time can lead to increased negative consequences.
Here are the most common:
- Falls, ataxia of gait.
- Burns.
- Pressure ulcers.
- Damage to organs such as the heart and eyes. In fact, optic neuropathy may develop, although it is not very frequent (Donnadieu-Rigole et al., 2014).
- Alterations in both the cerebellum and proprioception (feel the parts of the body) due to alcohol consumption. This can make walking properly and without help virtually impossible.
How can it be prevented?
According to Allen & Boskey (2016):
- An appropriate way to prevent this disease is by reducing or eliminating alcohol consumption. This is essential if you begin to notice the first symptoms.
- If leaving or decreasing alcohol intake is a problem, ask for help from a specialist.
- Become accustomed to a balanced and healthy diet.
- Perform periodic medical examinations if you tend to have deficiencies of vitamins and nutrients.
- Take vitamin supplements if necessary (always supervised by a doctor).
Forecast
The damage that has already occurred in the nerves can be permanent. This disease is not life-threatening, but it can seriously worsen the quality of life of the person who suffers it (Kantor, 2015). However, alcoholic neuropathy improves significantly after stopping alcohol consumption (Laker, 2015).
Bibliography
- Allen, S. &. (February 11, 2016). The After Effects of Alcoholism: Alcoholic Neuropathy. Retrieved from Healthline.
- Brillman, J. &. (2005). In a Page: Neurology. Massachusetts: Blackwell Publishing.
- Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: Possible mechanisms and future treatment possibilities. British Journal of Clinical Pharmacology, 73 (3), 348-362.
- Dina O.A., Gear, R.W., Messing, R.O., Levine, J.D. (2007). Severity of alcohol-induced painful peripheral neuropathy in female rats: role of estrogen and protein kinase (A and C epsilon) Neuroscience, 145: 350-6.
- Donnadieu-Rigole, H., Perney, P., Daien, V., Villain, M., Blanc, D., Michau, S., & Nalpas, B. (2014). The prevalence of optic neuropathy in alcoholic patients-A pilot study. Alcoholism: Clinical And Experimental Research, 38 (7), 2034-2038.
- Kandhare, A.D., Raygude, K.S., Ghosh, P., Ghule, A.E., & Bodhankar, S.L. (2012). Therapeutic role of curcumin in prevention of biochemical and behavioral aberration induced by alcoholic neuropathy in laboratory animals. Neuroscience Letters, (1), 18.
- Kantor, D. &. (January 6, 2015). Medline. Obtained from Alcoholic neuropathy.
- Laker, S. (April 21, 2015). Medscape.
- Mehta, S. S. (2016). Alcoholic neuropathy and remedies. Journal of Innovations in Pharmaceuticals and Biological Sciences, 3 (2), 66-70.
- Mellion, M.L., Silbermann, E., Gilchrist, J.M., Machan, J.T., Leggio, L., & de la Monte, S. (2014). Small-fiber degeneration in alcohol-related peripheral neuropathy. Alcoholism: Clinical And Experimental Research, 38 (7), 1965-1972.
- Tanwir, A. (2015). A case study of dietary deficiency on peripheral nerve Functions in chronic Alcoholic Patient. International Journal of Scientific & Technology Research, 4 (11): 341-344.
- Wikipedia. (S.f.). Retrieved on May 31, 2016, from Alcoholic polyneuropathy.
- Yerdelen, D., Koc, F. & Uysal, H. (2008). Strength-duration properties of sensory and motor axons in alcoholic polyneuropathy. Neurol Res. 30 (7): 746-50.