The alcoholic neuropathy is a neurological disorder characterized by degeneration of the axons and a decrease in myelin of neural fibers that are responsible for monitoring 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 abusive alcohol consumption. It is characterized mainly by strong pains, tremors and a feeling of weakness that begins in the extremities (hands and feet) and gradually extend 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 significant physical problems.
It is interesting to note that thiamine deficiency 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 problems of alcoholism. Evidently, it is more frequent in alcoholics who have consumed more time and who drink more. (Chopra & Tiwari, 2012). For this reason, most patients diagnosed are between 40 and 60 years old. (Laker, 2015)
It seems 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 to develop it?
Alcoholic neuropathy can appear if:
– Alcohol is consumed in large quantities over a prolonged 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 is stopped, these nutrients return to normal, although the damage already produced is permanent. (Allen, 2016)
– Family history of alcoholism.
When it starts?
The alcoholic neuropathy arises gradually, during months or years of excessive alcohol consumption. It is important to know that axonal degeneration usually appears before the first symptoms occur.
In most cases, deterioration begins first in the feet and legs and later in the hands and arms.
Signs and symptoms
The signs and symptoms may vary depending on the person. In most cases it arises slowly and progressively, although some people have an acute and rapid onset. In any case, 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 you can notice discomforts of both types 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 sharp in some people and in others more light and constant.
– Absence of sensations coming from the extremities. Patients may not feel where they are.
– Symmetric 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, with frequent burning of the feet.
– Decrease in fine motor skills.
– Muscular weakness.
– Loss of muscle mass and decrease of deep tendon reflexes.
– Loss of balance, possibly causing accidents and fractures.
– Erectile dysfunction in men.
– Frequent colds.
– Dizziness or lightheadedness (Allen, 2016)
– Urinary problems that include: incontinence, false sensation of having a full bladder and problems to start urinating.
– Diarrhea or constipation.
– Weight reduction.
– Damages cover more central body parts
– the skin becomes rough and dry (Mehta, 2016).
– Spasms and even atrophy of the muscles.
– Although it is not very frequent, you can get to alter the laryngeal nerve. This is observed by alterations in speech, hoarseness and difficulty swallowing (Laker, 2015).
Other symptoms linked to alcoholism can occur in the person with this disease such as liver diseases or varicose veins (Brillman, 2005).
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 the abuse of this substance or nutrient deficiency is more important for 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 decreases 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 ) has been verified directly in the spinal cord. In addition, ethanol also impairs axonal transport and alters the cytoskeleton of neurons (Laker, 2015).
However, it is still not known exactly how much alcohol is responsible for 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.
Sometimes, alcoholic neuropathy can be difficult to diagnose because of its resemblance to other degenerative polyneuropathies.
To make a safe diagnosis, other diseases 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.
– Post-polio syndrome.
– Neuropathy caused by drugs (such as disulfiram ).
First, a detailed history of your alcohol use, symptoms, and eating habits needs to be obtained from the patient.
The typical findings found in a physical examination of a person suffering from alcoholic neuropathy are the following:
– Proprioceptive decrease.
– Alterations in the thermal sensation.
– Little sensitivity to vibration or punctures with distribution in “glove and sock” (affectation of hands and feet symmetrically).
– Deficiency of muscle reflexes.
– Ankle weakness or dorsiflexion of the toes or ankles.
– In severe cases, atrophy of the intrinsic musculature of the foot.
– Ataxia of the march and pendular foot.
– Other damages related to alcohol abuse.
Laboratory tests that examine:
– Essentially, the levels of thiamine, vitamin B12 and folic acid.
– Increase 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 such as:
– X-ray of the affected areas.
– Electromyography (EMG): If muscle disorders are found in the extremities with this test, it is advisable to do it in more superior parts of the body to see the extension of the neuropathy.
– Tests of nervous conduction and speed of the conduction: it can help to detect the gravity of existing peripheral neuropathy. The driving speed is usually normal or slightly slower in patients with alcoholic neuropathy. The slowness increases when they are demyelinating neuropathies .
– Vibration uptake test: useful to observe 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 with non-alcoholic subjects (Mellion et al., 2004).
These tests can be done to rule out other disorders that give rise to similar symptoms:
– Existence in blood of toxic heavy metals, causing neuropathy.
– Globular sedimentation rate: appears in patients with neuropathy but due to inflammation.
– Test for HIV and venereal diseases: 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 interrupt the consumption of alcohol.
– Take supplements of B vitamins, mainly B12 and thiamin. Folic acid is also recommended.
– Eat the corresponding daily calories (Brillman, 2005).
– 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 relieves muscle and joint pain temporarily.
– Ankle and foot orthosis: it can help the patient improve his ankle proprioception, facilitate walking and reduce the likelihood of ankle sprains. Better to use the right shoes and 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 are:
– Increased motivation, assuming the advantages of leaving alcohol.
– Set feasible objectives to achieve
– Establishment of a commitment with the psychologist to meet the goals established each week.
– Change habits: at the beginning, you should avoid going to bars and parties. Get away from the “colleagues” with whom he went out to drink.
It would be advisable to enter a support group to fight against alcoholism such as Alcoholics Anonymous (AA).
Comprehensive physical therapy
– Exercises of amplitude of movements, in order to maintain a mechanics of normal gait and prevent contractures.
– Balance and walking training.
– Exercise the weakest muscles.
Recommended to develop nutritional strategies so that the patient receives the essential nutrients, especially in conditions of malnutrition.
Caution should be exercised with hot foot baths, as it can be dangerous. It must be borne in mind that these patients may have insensible limbs and do not perceive burns.
It is very important to encourage regular visits to health specialists to control 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 a change.
It is also essential to educate the patient to develop self-care behaviors. Teach him the negative effects that alcohol consumption has on his 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 the symptoms of pain produced by alcoholic neuropathy can be improved with the joint administration of curcumin and vitamin E (Kandhare et al., 2012).
– 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 they live to reduce their deficits, reduce dangers and maximize their independence)
In cases where there is very serious liver damage, a liver transplant should be considered.
We have found a case in which the subject recovered from alcoholic neuropathy when performing a liver transplant, in addition to improving their nutritional deficiencies.
Alcoholic neuropathy, if not treated and maintained for a long time, can increase the negative consequences.
Below, we present the most frequent:
– Falls, ataxia of the march.
– Pressure ulcers.
– Damage to organs such as the heart and eyes. In fact, optic neuropathy can develop, although it is not very frequent (Donnadieu-Rigole et al., 2014).
– Alterations both in the cerebellum and in proprioception (feeling the own body parts) due to alcohol consumption. This can make walking correctly and without help practically impossible.
How can it be prevented?
According to Allen & Boskey (2016):
– An adequate way to prevent this disease is 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.
– Habituarse 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).
Damage that has already occurred in the nerves can be permanent. This disease is not dangerous for life, 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).