From the Guidelines
Alcoholic neuropathy is a serious condition that requires immediate attention, and the most effective treatment is complete abstinence from alcohol, as it directly damages nerve fibers and interferes with nutrient absorption, particularly B vitamins that are crucial for nerve health. The effects of alcohol on peripheral nerves can be severe, resulting in symmetric peripheral neuropathy, as seen in patients with moderate forms of alcoholic liver disease 1.
Clinical Presentation
The clinical presentation of alcoholic neuropathy may include signs such as muscle wasting, malnutrition, and Dupuytren’s sign, in addition to symptoms of symmetric peripheral neuropathy 1. It is essential to note that the diagnosis of alcoholic liver disease (ALD) is frequently suspected upon documentation of excess alcohol consumption >30 g/d and the presence of clinical and/or biological abnormalities suggestive of liver injury 1.
Diagnosis and Treatment
While there is no single laboratory marker that definitely establishes chronic alcohol consumption, carbohydrate deficient transferrin (CDT) and gamma glutamyl transpeptidase (GGT) are the most frequently used markers to detect previous alcohol consumption 1. The treatment of alcoholic neuropathy involves complete abstinence from alcohol, nutritional supplementation, particularly with B vitamins, and pain management using medications such as gabapentin, pregabalin, or duloxetine.
Management and Prognosis
The management of alcoholic neuropathy also includes physical therapy to maintain muscle strength and improve coordination, as well as a balanced diet rich in proteins and vegetables to support nerve repair. Recovery from alcoholic neuropathy is possible but slow, often taking months to years, and some nerve damage may be permanent if alcohol consumption continues or if treatment is delayed. Therefore, it is crucial to prioritize complete abstinence from alcohol and early treatment to prevent further nerve damage and improve quality of life.
From the Research
Effects of Alcohol on Peripheral Nerves
The effects of alcohol (ethanol) on peripheral nerves can lead to alcoholic neuropathy, a condition characterized by:
- Spontaneous burning pain, hyperalgesia, and allodynia 2, 3
- Damage to nerves resulting from long-term excessive drinking of alcohol 2
- Impairment in axonal transportation, leading to axonal neuropathies 4
Pathogenesis of Alcoholic Neuropathy
The pathogenesis of alcoholic neuropathy is not well understood, but several mechanisms have been proposed, including:
- Activation of spinal cord microglia after chronic alcohol consumption 2
- Oxidative stress leading to free radical damage to nerves 2, 4
- Activation of mGlu5 receptors in the spinal cord 2
- Activation of the sympathoadrenal and hypothalamo-pituitary-adrenal (HPA) axis 2
- Nutritional deficiency, especially thiamine deficiency 2, 5
- Direct toxic effect of alcohol 5
Risk Factors and Prevalence
The prevalence of peripheral neuropathy amongst chronic alcohol abusers is 46.3% when confirmed via nerve conduction studies 6. The most important risk factor for alcohol-related peripheral neuropathy is the total lifetime dose of ethanol, although other risk factors have been identified, including:
Management and Treatment
Treatment for alcoholic neuropathy is directed towards halting further damage to the peripheral nerves and restoring their normal functioning, which can be achieved by: