Neuropathies, or clinical disorders of the nervous system, are a large group of heterogeneous diseases that affect the nerves responsible for making the body work . While some affect the peripheral nervous system, resulting in alterations in motor skills and sensitivity, others attack the autonomic nervous system.

Alcoholic neuropathy, a disorder of the nervous system caused by the consumption of alcohol , is of peripheral affectation. Let’s see what forms the nerve damage of alcoholic origin takes.

Clinic in alcoholic neuropathy

People who are dependent on alcohol have a pronounced effect on their nervous system. Almost 10% of alcoholics who consume high doses of ethanol chronically end up suffering from alcoholic neuropathy in one of its forms.

These patients with alcoholic neuropathy suffer damage to the axons of motor and sensory neurons . Bilateral paresthesias occur in both arms and legs, numbness, tingling sensation and paresthesias, which are more accentuated in hands and feet. In addition, gait and posture disorders due to degeneration or atrophy of the cerebellum may occur, as well as nystagmus, a brief, involuntary movement of the eyes.

Fortunately, the involvement of the autonomic nervous system, which maintains vital functions such as breathing, heart contractions, etc., is mild in this disease . The most relevant autonomic symptom is the inability to have an erection and maintain it, that is, impotence. However, autonomous symptoms do exist when alcoholic neuropathy is accompanied by a syndrome characteristic of alcohol-dependent people: Wernicke’s disease.

Wernicke’s Encephalopathy

Wernicke’s encephalopathy, which is not exclusive but particular to alcoholics, consists of the inability to move the eyes, the difficulty in coordinating organized movements and a confusional state where the patient is absolutely disoriented. When someone suffers this disease together with alcoholic neuropathy we speak of polyneuropathies, since both syndromes coexist.

This is a medical emergency requiring immediate administration of thiamine (vitamin B1). As this symptomatology is resolved, the patient begins to show an amnesiac picture. This is Korsakoff’s psychosis.

Korsakoff’s Syndrome

The second phase of this syndrome is called Korsakoff’s psychosis. It is characterized by the inability to remember past events in time (time gaps), confabulation and anterograde amnesia.

Because this pair of syndromes almost always occur together, we speak of a single Wernicke-Korsakoff syndrome, a two-phase disease where the most severe neurological symptoms of the first phase, when resolved, give way to the amnesiac phase of the second.

Causes of alcoholic neuropathy

Most of the neurological diseases associated with alcohol consumption are related to a vitamin deficit . Alcoholic beverages, in addition to inhibiting hunger through their psychoactive characteristics, contain many calories.

The brain, on receiving the signal that this hypercaloric intake has occurred, interprets that it should not eat any more and inhibits the hunger signal. Thus, the alcoholic feels satiated in spite of not having eaten anything nutritious .

In particular, as in the Wernicke-Korsakoff, thiamine plays a crucial role in the development and resolution of the clinical picture.

1. Thiamine deficit

It is frequent to find a nutritional deficit of this vitamin in patients who have abused alcohol in a chronic way, patients who vomit very frequently or patients who have undergone bariatric surgery.

Alcoholic neuropathy caused by thiamine deficiency begins after the body has been deprived of this vitamin for a long time. It starts with a slight loss of feeling, subtle burning sensations in the toes, and leg cramps. Later on, you will begin to lose feeling in your extremities.

Whether it is a pure alcoholic neuropathy or accompanied by Wernicke-Korsakoff, this deficit will be resolved with the intramuscular or intravenous administration of vitamin B1 .

2. Pyroxidine deficit

Although more rare, it is possible that neuropathy is partly caused by the absence of vitamin B6. Both its excess and absence can cause neurological damage , but in alcohol abuse only its deficit is found. Like thiamine, it can be detected by a blood test.

3. Pellagra

Pellagra is the deficiency of niacin (vitamin B3) due to malnutrition or alcoholism. The neurological manifestations are variable: they affect the central nervous system and also the peripheral nerves.

Prognosis

Alcoholic neuropathy is a severe neurological disease that must be treated immediately. Fortunately, its urgent management often leads to a partial recovery , without serious long-term consequences. Depending on the severity of the condition, it will take the person who has suffered the illness more or less time to recover.

Nowadays it is possible to make an accurate diagnosis of alcoholic neuropathy through the analysis to detect vitamin deficiencies and the electrodiagnostic tests of nerve conduction and electromyographs . In this way treatment can be administered quickly and effectively for a complete recovery.

Treatment

Medical intervention in cases of alcoholic neuropathy always involves the withdrawal of the substance that has produced it. In order to promote recovery, vitamin B supplements are also used, especially B12 and thiamine. As a support, it is important to ensure that the patients’ diet is sufficiently nutritious .