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Alcoholic neuropathy


Alternative names

Neuropathy - alcoholic; Alcoholic polyneuropathy

Definition

Alcoholic neuropathy is a disorder involving decreased nerve functioning caused by damage that results from excessive drinking of alcohol.

Causes, incidence, and risk factors

The cause of alcoholic neuropathy is controversial but may be the toxic effect of alcohol on nerve tissue. It is likely also associated with nutritional deficiencies and may be indistinguishable from nutrition-related neuropathies such as beriberi .

The most common symptoms are numbness, tingling, burning feet, or weakness. In severe cases, however, the autonomic nerves (those that regulate internal body functions) may be involved.

Prolonged heavy use of alcohol, or alcoholism that is present for 10 years or more indicates high risk for alcoholic neuropathy.

Symptoms

  • Numbness
  • Abnormal sensations (paresthesia); "pins and needles"
  • Painful sensations
  • Muscle weakness
  • Muscle cramps or muscle aches
  • Heat intolerance , especially after exercise
  • Impotence (in men)
  • Difficulty urinating
    • Incontinence (leaking urine)
    • Feeling of incomplete bladder emptying
    • Difficulty beginning to urinate
  • Constipation
  • Diarrhea
  • Nausea, vomiting

Additional symptoms that may be associated with this disease:

  • Swallowing difficulty
  • Speech impairment
  • Loss of muscle function or feeling
  • Muscle contractions or spasm
  • Muscle atrophy
  • Movement, dysfunctional
  • Hoarseness or changing voice
  • Eyelid drooping (ptosis)

Note: Changes in muscle strength and/or sensation usually occur on both sides of the body and are more common in the legs than in the arms. Symptoms may develop gradually and progressively become worse over time.

Signs and tests

Results of a neurological exam may be abnormal. Reflexes may be reduced and localized nerve abnormalities may be present. Neurologic deficits are usually symmetrical (affecting both sides of the body).

Signs of autonomic nervous system dysfunction may be present. Eye inspection may show decreased pupil response or other abnormality. Blood pressure may show orthostatic changes (a fall in blood pressure when the person rises to a standing position).

Lab tests may be performed as indicated by the history, signs, and symptoms to rule out other possible causes of neuropathy.

  • Nutritional studies may show deficiencies of thiamine (vitamin B-1), pyridoxine (vitamin B-6), pantothenic acid and biotin , vitamin B-12 , folic acid , niacin (vitamin B-3), vitamin A , or other deficiencies. Alcoholism is a risk factor for nutritional deficiency.
  • Serum chemistries may show abnormalities (see chem-20 ).
  • Nerve conduction tests and EMG (a test of electrical activity in muscles) may be used to determine the extent of neurologic damage. Nerve biopsy may be used to rule out other possible causes of the signs and symptoms.
  • An upper GI and small bowel series may show decreased motility (movement), delayed emptying of the stomach, or other abnormalities. This study may be used to rule out physical obstruction as a cause of vomiting or other GI (gastrointestinal) symptoms.
  • EGD (esophagogastroduodenoscopy) is used to rule out physical obstruction as a cause of gastrointestinal (GI) symptoms.
  • Isotope studies may indicate gastroparesis (decreased gastric motility).
  • VCUG ( voiding cystourethrogram ) may show decreased bladder emptying caused by damage to the nerves controlling the bladder.

Other tests may be performed to determine the presence and extent of other neurologic losses.

Treatment

Treatment goals (assuming the immediate alcohol problem has been addressed) include controlling symptoms, maximizing ability to function independently, and preventing injury. It is important to supplement the diet with vitamins including thiamine and folic acid.

Physical therapy and/or use of orthopedic appliances such as splints may be necessary to maximize muscle function and to maintain useful positioning of the limbs.

Medication may be used if necessary to treat pain or uncomfortable sensations. Response to medications varies. The least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.

Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine.

Positioning, or the use of a bed frame that keeps the covers off the legs, may reduce pain for some people.

Treatment of autonomic dysfunction (such as blood pressure problems, difficulty with urination, and slow gastrointestinal movement) may be necessary. Treatment may be chronic and long term, and response to treatment varies.

Many treatments may be tried before finding one that is successful in reducing symptoms. Wearing elastic stockings, eating extra salt, sleeping with the head elevated, or using medications such as fludrocortisone may reduce postural blood pressure changes (orthostatic hypotension ).

Manual expression of urine, intermittent catheterization, or medications such as bethanechol may be necessary to treat bladder dysfunction.

Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms may respond poorly to treatment.

It is important to protect arms and legs with reduced sensation from being injured. This may include checking the temperature of bath water to prevent burns, change in footwear, frequent inspection of shoes to reduce injury caused by pressure or objects in the shoes, or other measures. Extremities should be guarded to prevent injury from pressure.

Use of alcohol should be stopped to reduce progression of the damage. Treatment of alcoholism may include psychiatric interventions, social support such as AA (Alcoholics Anonymous), medications, and behavior modification.

Expectations (prognosis)

Damage to nerves from alcoholic neuropathy is usually permanent and may be progressive if alcohol use continues. Symptoms vary from mild discomfort to severe disability. The disorder is usually not life-threatening, but may severely compromise the quality of life.

Complications

  • Disability
  • Discomfort or pain, chronic
  • Injury to extremities

Calling your health care provider

Call for an appointment with your health care provider if symptoms indicate alcoholic neuropathy may be present.

Prevention

Avoid or minimize alcohol use. Total abstinence from alcohol may be necessary for persons with alcoholism.

Update Date: 10/23/2003

Elaine T. Kiriakopoulos, M.D., M.Sc., Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA. Review provided by VeriMed Healthcare Network.

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Last updated: Tue, 06 Jan 2009 00:20:03 GMT
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