Alcohol Neuropathy

Alcoholic neuropathy is one of the varieties of damage to the human body by alcoholic beverages and metabolites of ethyl alcohol. It reflects the effect of alcohol on the peripheral nervous system. The more correct is the term "alcoholic polyneuropathy", because the toxic effect of alcohol is always spread on a lot of nerve fibers, not just one nerve. According to recent studies, alcohol abuse always causes damage to the peripheral nervous system. Previously it was believed that up to 70% of people suffering from chronic alcoholism, in one way or another have impairments from the peripheral nerves. With the advent of additional research methods, in particular electroneuromyography, this indicator has become almost 100%. Simply clinical symptoms of this condition do not appear immediately. From this article you can learn about the main reasons for the development of alcoholic polyneuropathy, its symptoms, methods of diagnosis and treatment.

In itself, the name "alcoholic polyneuropathy" does not say anything to an ordinary person. But in fact, everyone who saw a patient suffering from alcoholism, contemplated and polyneuropathy. Thin limbs with swollen, cyanotic brushes and feet, a little strange gait to everyone are conspicuous. These are the external signs by which the alcoholic is recognized (in addition to a specific type of face). This is the manifestation of alcoholic polyneuropathy. Of course, this is already a long-running and long-existing option, and in the initial stages the symptoms may not be noticeable to others.

Alcoholic polyneuropathy is not the only result of alcohol abuse. Along with the defeat of the peripheral nervous system, ethyl alcohol affects the central nervous system (causing encephalopathy), and muscles (becoming the cause of myopathy), and liver (cirrhosis), and many others organs. Specific memory disorders due to alcohol - Korsakov's syndrome, as well as a number of other pathological conditions (alcoholic degeneration of the cerebellum, corpus callosum, central pontinous myelinolysis and so Further). Abundant and systematic libations do not pass for the body without a trace never.

Causes of alcoholic polyneuropathy

Peripheric nerves are affected by alcoholism for two main reasons:

• direct toxic effects of ethyl alcohol and its metabolites (acetaldehyde) on nerve fibers;
• metabolic disorders resulting from deficiency of B vitamins.

If the first paragraph is more or less clear, then the second reason requires some clarification. How is alcohol abuse due to vitamin deficiency? Let's find out.

Alcohol with its regular and excessive use affects the gastrointestinal tract. There are gastritis, enteritis, hepatitis, pancreatitis with a violation of the assimilation of food, including vitamin B group vitamins. In addition, usually people with alcoholism do not care too much about the usefulness of their food, which also becomes a prerequisite for the emergence of vitamin deficiencies. And the functioning of the nervous system is highly dependent on the B vitamins. When they become insufficient, the supply of nerve conductors is disrupted, which inevitably leads to a disruption in their function.

There is a definite dependence on the dose of alcohol consumed. The larger the dose, the greater the vitamin deficiency and the immediate toxic effect. The dose itself may not be the same for different people, since the number of enzymes that break down ethyl alcohol in each organism individually. Someone becomes an alcoholic from a small amount of alcohol, but someone needs a daily dose of this, l.

Both causes of alcoholic polyneuropathy lead to the destruction of the structure of the nerve fiber, its base, called the axon. The so-called axonal degeneration develops. In addition, the coating of the nerve conductor (myelin) deteriorates, which is called demyelination. These processes lead to the shutdown of the transmission of nerve impulses from the affected fiber to the structures innervated by it (skin, muscles, vessels, glands). Pathological changes in these formations develop, which is manifested by a number of symptoms.

Symptoms of alcoholic polyneuropathy

Initially, pathological changes in nerve fibers do not manifest themselves in any way, and the patient has no complaints. In this stage, only electroneuromyography reveals a pathological transformation of the peripheral nerves. But gradually compensatory opportunities are lost, and complaints arise.

Patients talk about pain in the limbs. The longest nerves suffer first. Therefore, the pain starts to bother in the legs. The pain is of a different nature: most often they are burning, shooting. Along with pain, patients experience paresthesia - uncomfortable, incapable of accurately describing the sensations of crawling, tingling, burning, itching in the feet, calf muscles. All sensations are amplified at night and interfere with rest. The pain is provoked by the touch of clothing, the dressing of shoes and lasts much longer than the irritation applied. With time, as the process progresses, the pain sensations decrease, which does not indicate an improvement in the condition. On the contrary, it speaks of the destruction of the nerve fiber completely.

In connection with the damage of sensitive fibers of peripheral nerves, the perception not only of touches and pain stimuli, but also a feeling of warm and cold, that is, the temperature sensitivity. The involvement of conductors of so-called deep sensitivity is associated with a loss of the feeling of cover underfoot. Such patients do not feel the hardness of the ground under their feet, they can stumble on stones and small obstacles, because they simply do not feel them. They have to look all the time at their feet to compensate for this defect with the help of visual control. All these changes, along with pain syndrome, are called sensory polyneuropathy.

Gradually, the motor fibers are involved, that is, those that carry impulses to the muscles. Muscles do not receive stimulating impulses from the nervous system. This leads to the appearance of weakness in the muscles, breaks their trophic, which, in the final analysis, causes their atrophy. Legs lose weight because of this. The process spreads from the bottom up, that is, initially there is weakness in the feet (it becomes difficult to bend and unbend), then the calf muscles are involved, and then the muscles of the thigh. Moving without additional means of support becomes difficult, and sometimes impossible. Because of the defeat of motor fibers, reflexes from the lower limbs (knee, Achilles) are reduced, and then completely lost. Muscle tone also decreases, they become flabby. These changes are called motor polyneuropathy.

Involving vegetative fibers in the pathological process leads to the occurrence of trophic disorders. The skin on the legs becomes hyperpigmented, dry, scaly, and possibly ulcers. Nails thicken and exfoliate. The hair falls out, the skin feels cold, the feet get a bluish tint, sweat and sweat. These are manifestations of autonomic polyneuropathy.

Rarely, when individual symptoms of alcoholic polyneuropathy arise in isolation. Basically, the first to occur are sensitive disorders, then trophic, and then motor. The changes are always symmetrical, that is, they are the same on both sides. The process captures not only the lower limbs. If alcohol abuse continues, then similar changes occur in the hands. With prolonged experience of the disease, loss of control over the function of pelvic organs is possible.

There is a rather rare variant of alcohol damage to the peripheral nervous system in the form of optic nerve neuropathy. The second name is alcoholic amblyopia. This condition manifests itself by a decrease in visual acuity, which progresses within a few weeks. If treatment is not started on time, then complete loss of vision without the potential for recovery is possible.

Diagnostics

Throughout the world, it is commonly believed that in order to establish a diagnosis of alcoholic polyneuropathy, it is necessary to identify at least two peripheral nerves and one muscle. In this case, the patient must make appropriate complaints, and with an objective examination - to detect sensitive, vegetative and motor disorders.

Another important point is confirmation of pathological changes of the alcoholic genesis. After all, polyneuropathy can develop in many other cases, and patients themselves often deny addiction to alcoholic beverages. In this case, a survey of relatives helps to establish the true cause of changes in the peripheral nervous system.

From additional research methods for the diagnosis of alcoholic polyneuropathy successfully used electroneuromyography. It helps to identify even such changes in the nerves that clinically do not yet manifest themselves.

Treatment of alcoholic polyneuropathy

Treatment of alcoholic polyneuropathy is carried out by conservative methods.

The first condition for achieving a positive result is the refusal to drink alcohol. Without observing this condition, regression of symptoms is impossible, and the cost of medicines is useless.

The second condition for treatment is to provide adequate nutrition to provide the body with sufficient nutrients and vitamins.

From medicinal agents use:

• vitamin B1 (thiamin) at first intramuscularly, and then in the form of tablets for a long period of 2-3 months. In recent years, preference has been given to Benfothiamine (a fat soluble analog of thiamine). It has a greater effect at a lower dosage;
• vitamin B6 (pyridoxine);
• folic acid;
• drugs that improve the blood supply of peripheral nerves, facilitate venous outflow, strengthen the vessels (Vinpocetine (Cavinton), Emoxipin, Pentoxifylline (Curantil), Xanthinal nicotinate);
• antioxidants (preparations of α-lipoic acid - Berlition, Tiogamma, Espa-lipon, Oktolipen);
• neurometabolic and neurotrophic substances (Solcoseryl (Actovegin), choline alfoscerate (Gliatilin), Cortexin, Ginkgo biloba extract (Tanakan, Bilobil), Semax and others);
• Neuromidine (to improve neuromuscular conduction);
• hepatoprotectors (since without normalizing liver function it is difficult to ensure sufficient absorption of vitamins from the gastrointestinal tract).

Treatment of pain syndrome with alcoholic polyneuropathy carries a certain difficulty, since it is not so easy to eliminate pain in this case. To do this, use:

• non-steroidal anti-inflammatory drugs (Diclofenac, Nimesulide, Ibuprofen, Meloxicam and others);
• anticonvulsants (Carbamazepine (Finlepsin), Gabapentin (Gabagamma, Neurontin), Pregabalin (Lyrics);
• antidepressants (Amitriptyline, Paroxetine).

Many of the drugs used to treat the pain syndrome are not compatible with the use of alcohol. Therefore (including) refusal of alcohol should be complete.

In addition to medical measures, in complex treatment use physiotherapy methods, physiotherapy exercises, acupuncture.

For the sake of justice, it should be said that alcoholic polyneuropathy is successfully treated with a small experience of alcohol abuse. When the changes have gone far enough, and the nerve fibers are destroyed by alcohol, then they can not be completely restored.You can only reduce the symptoms and stabilize the pathological process. This does not mean that treatment is useless. If the patient continues to consume alcohol in the absence of medication, this can lead to gross disability, to the inability to serve himself. There is always a certain potential for recovery. The most important thing is to stop drinking alcohol.

Thus, alcoholic polyneuropathy is an inevitable consequence of alcohol abuse. The disease sneaks up unnoticed, but significantly changes the patient's life. With the timely abandonment of alcohol and rational treatment, complete recovery is possible, in the rest of cases, pathological changes will be irreversible.