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Alcoholic polyneuropathy
Last reviewed: 23.04.2024
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Alcoholic polyneuropathy is the most frequent neurological complication of chronic alcoholism, which develops in the majority of individuals who suffer from chronic alcoholism for a long time.
The clinical signs of alcoholic polyneuropathy were first described in the second half of the 18th century by Lettsom (1787).
[Causes of the alcoholic polyneuropathy
The disease is mainly based on axonal degeneration. To a lesser degree, the myelin sheath suffers. Axonal degeneration is caused by the direct action of toxic metabolites of alcohol on the nerve fiber and a deficiency of B vitamins (primarily thiamine). The latter is caused by a meager and monotonous diet of the patient, as well as a violation of the resorption of vitamin B, due to gastroenteritis. In addition, it is possible to influence other factors, including genetic, autoimmune, age, etc.
Symptoms of the alcoholic polyneuropathy
Alcoholic polyneuropathy is a symmetric sensorimotor neuropathy. The first signs can be a moderate weight loss of the leg muscles, a decrease and fall of the Achilles and knee reflexes. Later, paresthesia, hyperesthesia with elements of hyperpathy, numbness, pain in the feet, painful spasms of the calf muscles join. In some patients, allodynia is noted. Paresis of extensor fingers and feet usually develop gradually. Weakness in the feet leads to changes in the gait of the "steppe" type. Gradually these symptoms extend to the proximal parts of the lower extremities, in severe cases - to the distal parts of the hands and lower parts of the trunk. The disease is slowly progressing for months and years.
Diagnostics of the alcoholic polyneuropathy
The examination reveals the slimming muscles of the legs and feet, reducing pain and temperature sensitivity in the distal parts of the extremities (such as "gloves" and "socks"). Often find other options for sensitive disorders. In most patients Achilles reflexes are reduced or drop out, in half of patients the knee reflex is weakened or absent, more rarely - reflexes from the upper extremities. Often reveal soreness at palpation of nerve trunks and muscles. There are vegetative disorders in the form of distal hyperhidrosis, trophic skin and nail disorders, swelling and hyperpigmentation, changes in the coloration of the skin. Possible changes in pupillary reactions, orthostatic hypotension, impaired urination, impotence, dysfunction of the digestive tract.
Instrumental methods
In subclinical flow of alcoholic polyneuropathy, it is shown the conduct of needle electroneuromyography. Histologically, signs of distal degeneration of axons and secondary myelinopathy are revealed.
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Treatment of the alcoholic polyneuropathy
Recommend the rejection of alcohol, a full, balanced diet, the introduction of thiamine in combination with other B vitamins, drugs that improve microcirculation and have a metabolic effect. It is advisable to begin treatment of alcoholic polyneuropathy with parenteral administration of thiamine (2-4 ml of a 5% solution intramuscularly).
After achieving the improvement, they switch to taking 100 mg 2-3 times a day. With concomitant lesions of the liver, alpha-lipoic acid (espolipon) is administered parenterally (600 mg intravenously every day or every other day, 20 administrations), and then inside 600 mg for 1-2 months. Physical exercises are shown to prevent contractures and strengthen muscles.