Alcoholic neuropathy

Definition

Alcoholic neuropathy is a disorder involving decreased nerve functioning caused by damage that results from excessive drinking of alcohol.

Alternative Names

Causes

The cause of alcoholic neuropathy is controversial but may be the toxic effect of alcohol on nerve tissue. It is likely also associated with nutritional deficiencies and may be indistinguishable from nutrition-related neuropathies such as beriberi.

The most common symptoms are numbness, tingling, burning feet, or weakness. In severe cases, however, the autonomic nerves (those that regulate internal body functions) may be involved.

Prolonged heavy use of alcohol, or alcoholism that is present for 10 years or more indicates high risk for alcoholic neuropathy.

Symptoms

• Numbness
• Abnormal sensations; "pins and needles"
• Painful sensations
• Muscle weakness
• Muscle cramps or muscle aches
• Heat intolerance, especially after exercise
• Impotence (in men)
• Difficulty urinating
  • Incontinence (leaking urine)
  • Feeling of incomplete bladder emptying
  • Difficulty beginning to urinate
• Constipation
• Diarrhea
• Nausea, vomiting

Additional symptoms that may be associated with this disease:

• Swallowing difficulty
• Speech impairment
• Loss of muscle function or feeling
• Muscle contractions or spasm
• Muscle atrophy
• Movement, dysfunctional

Note: Changes in muscle strength or sensation usually occur on both sides of the body and are more common in the legs than in the arms. Symptoms may develop gradually and slowly become worse over time.

Exams and Tests

Results of a neurological exam may be abnormal. The person may have reduced reflexes signs of local nerve problems. Neurological problems usually affect both sides of the body.

An eye exam may show decreased pupil response or other problem. Blood pressure may fall when the person rises to a standing position.

Alcoholism is a risk factor for nutritional deficiency. Nutritional studies may show deficiencies of thiamine (vitamin B1), pyridoxine (vitamin B6), pantothenic acid and biotin, vitamin B12, folic acid, niacin (vitamin B3), vitamin A, or other deficiencies.

Additional tests may be done to rule out other possible causes of neuropathy. Tests may include:

• Serum chemistries
• Nerve conduction tests
• EMG
• Nerve biopsy
• Upper GI and small bowel series
• EGD (esophagogastroduodenoscopy)
• Isotope studies
• Voiding cystourethrogram

Treatment

Treatment goals (assuming the immediate alcohol problem has been addressed) include controlling symptoms, maximizing ability to function independently, and preventing injury. It is important to supplement the diet with vitamins including thiamine and folic acid.

Physical therapy and orthopedic appliances such as splints may be necessary to maximize muscle function and to maintain useful positioning of the limbs.

Medication may be used if necessary to treat pain or uncomfortable sensations. Response to medications varies. The least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.

Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin

Positioning, or the use of a bed frame that keeps the covers off the legs, may reduce pain for some people.

Treatment of blood pressure problems, difficulty with urination, and slow gastrointestinal movement may be necessary.

Many treatments may be tried before finding one that is successful in reducing symptoms. Wearing elastic stockings, eating extra salt, sleeping with the head elevated, or using medications such as fludrocortisone may reduce postural blood pressure changes (orthostatic hypotension).

Manual expression of urine, intermittent catheterization, or medications such as bethanechol may be necessary to treat bladder dysfunction.

Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms may respond poorly to treatment.

It is important to protect arms and legs with reduced sensation from being injured. This may include checking the temperature of bath water to prevent burns, change in footwear, frequent inspection of shoes to reduce injury caused by pressure or objects in the shoes, or other measures. Extremities should be guarded to prevent injury from pressure.

Use of alcohol should be stopped to reduce progression of the damage. Treatment of alcoholism may include psychiatric interventions, social support such as AA (Alcoholics Anonymous), medications, and behavior modification.

Outlook (Prognosis)

Damage to nerves from alcoholic neuropathy is usually permanent and may be progressive if alcohol use continues. Symptoms vary from mild discomfort to severe disability. The disorder is usually not life-threatening, but may severely compromise the quality of life.

Possible Complications

• Disability
• Discomfort or pain, chronic
• Injury to extremities

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms indicate alcoholic neuropathy may be present.

Prevention

Avoid or minimize alcohol use. Total abstinence from alcohol may be necessary for persons with alcoholism.