The alcoholic neuropathy It is a neurological disease characterized by a degeneration of the axons and a decrease in the myelin of the neural fibers that are in charge of controlling the sensory system and the motor system. This causes an imbalance in the functioning of our nervous system; that is, the peripheral nerves deteriorate due to abusive alcohol consumption.
Alcoholic neuropathy is mainly characterized by severe pain, tremors and a feeling of weakness that begins in the extremities (hands and feet) and gradually spreads to more central parts of the body..
This pathology can have several levels of severity, even sometimes the symptoms are difficult to recognize. The most severe cases will lead to significant physical problems.
It is interesting to note that thiamine deficiency gives much more variability to the presentation of alcoholic neuropathy.
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In the United States, neuropathy prevails in between 22% and 66% of people with chronic alcohol problems. Obviously, it is more frequent in alcoholics who have been consuming for a longer time and who drink more. For this reason, the majority of diagnosed patients are between 40 and 60 years old..
On the other hand, it seems to be more frequent in women than in men, as shown in a study by Dina et al. (2007): "Alcoholic neuropathy appears more rapidly and more severely in female rats than in males."
Alcoholic neuropathy can appear if:
- Alcohol is consumed in large amounts over a long period of time (about 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 nerve function and alcohol seems to alter their levels. If consumption is stopped, these nutrients return to normal, although the damage already produced is permanent.
- Family history of alcoholism.
Alcoholic neuropathy develops gradually, over months or years of heavy alcohol use. It is important to know that axonal degeneration usually appears before the first symptoms appear..
In most cases, the deterioration begins first in the feet and legs and later in the hands and arms..
Signs and symptoms can vary from person to person. In most cases it appears slowly and progressively, although some people present an acute and rapid onset. However, it can sometimes be asymptomatic and is only recognized with a thorough medical examination..
First, the sensory system is damaged and over time the motor system deteriorates, although in rare cases discomfort of both types can be noticed at the same time. As we will see below, these symptoms can be very disabling for those who suffer from it:
- Unpleasant sensation of tingling, cramps or numbness of the extremities (paresthesia), even in more severe cases pain may appear. This pain can vary, being sharp and stabbing in some people and more mild and constant in others..
- Absence of sensations coming from the extremities. Patients may not feel what position they are in.
- Symmetric motor alterations (if the disease affects the right foot, it will also affect the left almost simultaneously).
- Heat intolerance of the affected areas, with burning feet being frequent.
- Decreased fine motor skills.
- Muscular weakness.
- Loss of muscle mass and decreased deep tendon reflexes.
- Loss of balance, which can cause possible accidents and fractures.
- Erectile dysfunction in men.
- Frequent colds.
- Dizziness or lightheadedness.
- Urinary problems including: incontinence, false feeling of having a full bladder, and trouble starting to urinate.
- Diarrhea or constipation.
- Decrease in weight.
Long-term:
- Damage encompasses more central parts of the body.
- skin becomes rough and dry.
- Spasms and even muscle atrophy.
- Although it is not very frequent, the laryngeal nerve can be altered. This is seen by speech disturbances, hoarseness, and difficulty swallowing..
Other symptoms linked to alcoholism can occur in the person with this disease such as liver disease or varicose veins..
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 abuse of this substance or nutrient deficiency is more important for the origin of alcoholic neuropathy.
This is understandable, since alcoholics will lead a more irregular lifestyle, probably related to poor eating habits..
In addition, alcohol decreases the appetite, since it affects the stomach causing nausea, vomiting and gastritis. It also causes the lining of the digestive system to alter, decreasing the absorption of nutrients..
This has been observed in studies with rats, in which the neurotoxic effect of acetaldehyde (a metabolite of ethanol) has been found directly on the spinal cord. Furthermore, ethanol also impairs axonal transport and alters the cytoskeleton of neurons.
However, it is not yet known exactly how much alcohol is causing the symptoms. Many people drink a lot of alcohol for a long time and eat in a balanced way, however, they do not have this disease. So we can say that diet plays a fundamental role in the development of alcoholic neuropathy.
Alcoholic neuropathy can sometimes be difficult to diagnose because of its resemblance to other degenerative polyneuropathies. To make a safe diagnosis, other diseases must first be ruled out, such as:
- Beriberi (thiamine deficiency).
- Amyotrophic Lateral Sclerosis.
- Diabetic neuropathy.
- Folate deficiency.
- Lack of vitamin B12.
- Charcot Marie Tooth disease.
- Diabetic lumbosacral plexopathy.
- Multiple mononeuritis.
- Postpolio syndrome.
- Medication-induced neuropathy (such as disulfiram).
First, a detailed history of alcohol use, symptoms, and eating habits needs to be obtained from the patient. Typical findings found on a physical exam of a person with alcoholic neuropathy include the following:
- Proprioceptive decline.
- Alterations in thermal sensation.
- Low sensitivity to vibration or punctures with a “glove and sock” distribution (symmetrically affected hands and feet).
- Muscle reflex deficiency.
- Ankle weakness or dorsiflexion of the toes or ankle.
- In severe cases, atrophy of the intrinsic muscles of the foot.
- Gait ataxia and pendulum foot.
- Other harms related to alcohol abuse.
Laboratory tests that examine:
- Essentially, levels of thiamine, vitamin B12, and folate.
- Increase of enzymes in the liver.
- Creatinine level (a high level reflects kidney failure that can cause peripheral neuropathy).
- Estimate blood sugar levels to rule out diabetes.
Imaging studies are also recommended such as:
- X-ray of the affected areas.
- Electromyography (EMG): If muscle changes are found 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 and conduction velocity tests: can help detect the severity of existing peripheral neuropathy. Driving speed is usually normal or slightly slower in patients with alcoholic neuropathy. Slowness increases when they are demyelinating neuropathies.
- Vibration uptake test: useful for observing the first signs of alcoholic neuropathy.
- Skin biopsy: a study showed that this disease could be diagnosed through a skin biopsy that detected the density of nerve fibers. Nerve fibers were found to be significantly less dense in the group of alcoholic subjects compared to non-alcoholics.
These tests can be done to rule out other disorders that cause similar symptoms:
- Existence in blood of toxic heavy metals, causing neuropathy.
- Erythrocyte sedimentation rate: appears in patients with neuropathy but due to inflammation.
- HIV and venereal disease test: symmetric polyneuropathies can be early manifestations of HIV and syphilis.
Currently, treatments are focused on alleviating the symptoms and stopping the progression of the disease:
- The main thing to stop the development of this disease is to stop drinking alcohol.
- Take supplements of B vitamins, mainly B12 and thiamine. Folic acid is also recommended.
- Eat the corresponding daily calories.
- Drugs to reduce pain: gabapentin, amitriptyline, or over-the-counter drugs such as aspirin or acetaminophen.
- Topical cream: capsaicin is also recommended, a natural chemical compound from plants that temporarily relieves muscle and joint pain.
- Ankle and foot orthosis: It can help the patient to improve their proprioception of the ankle, facilitate walking and reduce the likelihood of ankle sprains. Better to use the right shoes and that have the area of the toes wider. This would prevent ulcers.
This intervention should be focused on helping the person to stop drinking alcohol. Among the existing strategies, the following stand out:
- Increased motivation, assuming the benefits of quitting alcohol.
- Set achievable goals to achieve.
- Establishing a commitment with the psychologist to meet the goals set each week.
- Change habits: at first, you should avoid going to bars and parties. Get away from the "colleagues" with whom you went out to drink.
-It would be advisable to join a support group to fight against alcoholism such as Alcoholics Anonymous (AA).
- Range of motion exercises, in order to maintain normal gait mechanics and prevent contractures.
- Balance and gait training.
- Exercise weaker muscles.
Recommended to develop nutritional strategies so that the patient receives essential nutrients, especially in conditions of malnutrition.
Caution should be exercised with hot foot baths, as they can be dangerous. It must be taken into account that these patients may have insensitive limbs and do not perceive burns.
It is very important that regular visits to health specialists are encouraged to monitor the progression of alcoholic neuropathy. In addition, it is useful to evaluate if the treatments are being effective or if it is better to make any changes.
It is also essential to educate the patient to develop self-care behaviors. Teach you the negative effects that drinking alcohol has on your balance, strength, perception, and gait. Also point out the importance of adequate nutrition.
According to a recent study in rats, it has been shown that pain symptoms caused by alcoholic neuropathy can improve with the joint administration of curcumin and vitamin E.
- Improve the adaptation of the person to their environment by developing training in activities of daily living (ADL).
- Transform the environment of the person if necessary (adapt the environment in which he lives to reduce his deficits, reduce dangers and maximize his independence).
In cases where there is very severe liver damage, a liver transplant should be considered..
A case has been found in which the subject recovered from alcoholic neuropathy after undergoing a liver transplant, in addition to improving his nutritional deficiencies.
Alcoholic neuropathy if it is not treated and is maintained for a long time, can increase the negative consequences. Here are the most common:
- Falls, gait ataxia.
- Burns.
- Pressure ulcers.
- Damage to organs such as the heart and eyes. In fact, optic neuropathy can develop, although it is not very common..
- Alterations in both the cerebellum and proprioception (feeling one's own body parts) due to alcohol consumption. This can make walking properly and without assistance practically impossible..
According to Allen & Boskey:
- An appropriate way to prevent this disease is by reducing or eliminating alcohol consumption. This is essential if the first symptoms begin to appear..
- If stopping or reducing alcohol intake is a problem, seek help from a specialist.
- Get used to a balanced and healthy diet.
- Get regular medical exams if you tend to have vitamin and nutrient deficiencies.
- Take vitamin supplements if necessary (always supervised by a doctor).
Damage that has already occurred to the nerves may be permanent. This disease is not life threatening, but it can seriously worsen the quality of life of the person who suffers from it. However, alcoholic neuropathy improves significantly after stopping alcohol consumption..
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