Alcoholic polyneuropathy (neuropathy)

What is alcoholic polyneuropathy?

Alcoholic polyneuropathy (ICD 10 code - G62.1) is a neurological disease that occurs as a result of extensive damage to nerve cells by toxic breakdown products of ethyl alcohol. Most often, the disease develops in chronic alcoholics; much less often it is diagnosed after acute ethyl poisoning.

Under the influence of alcohol metabolites, the nerve fibers of the peripheral nervous system are destroyed. The transmission of nerve signals stops, which leads to tissue destruction. The sensitivity of the limbs decreases, cognitive functions are impaired, and movement disorders are observed. The patient develops a special, so-called “alcoholic” gait. That is, a person cannot walk smoothly without staggering, even when sober.

Alcohol abuse

In addition to polyneuropathy, damage to the central nervous system by ethanol can cause encephalopathy.

Diagnostics

It is generally accepted throughout the world that to establish a diagnosis of alcoholic polyneuropathy, it is necessary to identify damage to at least two peripheral nerves and one muscle. In this case, the patient must present relevant complaints, and an objective examination should reveal sensory, autonomic and motor disorders.

CM. SEE ALSO: Treatment of diabetic polyneuropathy of the lower extremities

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

Electroneuromyography has been successfully used as an additional research method for diagnosing alcoholic polyneuropathy. It helps to identify even changes in nerves that do not yet manifest themselves clinically.

Causes

Alcohol toxins negatively affect neurons, disrupting the metabolic processes taking place in them. The following factors can provoke the disease:

• consumption of low-quality alcohol, surrogates;
• chronic alcoholism;
• the body's inability to neutralize ethanol metabolites (due to age, cancer, genetic disorder, or weakening of the body);
• lack of vitamins (especially group B), beneficial elements;
• liver diseases (hepatitis, cirrhosis);
• metabolic disease;
• heredity;
• long-term (usually incorrect) use of certain medications.

Sleeping in an uncomfortable position after taking a large dose of alcohol is another reason why alcoholics' legs fail. This leads to compression of certain areas of the fibers and their damage. The disease can also occur after prolonged heavy drinking.

Causes and risk factors

The main cause of damage to peripheral nerves is the direct damaging effect of alcohol and its metabolites on nervous tissue.

Other reasons:

• disruption of microcirculation in the peripheral blood supply to nerve fibers;
• toxic damage to the tissues of the liver and intestines and, as a consequence, a violation of the metabolism of vitamin B1 (hypovitaminosis B1), which is a regulator of metabolism and plays an important role in the conduction of nerve impulses at synapses;
• periodic episodes of compression of nerve trunks due to prolonged stay in one position during intense intoxication and, as a consequence, developing compression-ischemic changes.

What does a damaged nerve look like in alcoholic polyneuropathy?

The main risk factor for the development of chronic alcoholism, a precursor to alcoholic polyneuropathy, is the hereditary feature of the ALDH1 and ALDH4 genes, which encode the key enzymes for ethanol conversion - alcohol and acetal dehydrogenase. Researchers associate the pathology of these genes with the failure of the mechanisms for neutralizing toxic intermediate products of ethyl alcohol and, accordingly, a high risk of developing alcoholism (50%).

Forms

The classification of the disease is based on the clinical picture in a particular case. Depending on the form of the disease, the patient exhibits different symptoms and, accordingly, different therapy is prescribed.

Forms of alcoholic polyneuropathy:

1. Subclinical - nerve cells are just beginning to deteriorate, there are no obvious symptoms yet, sensitivity, motor skills, and reflexes are slightly reduced.
2. Sensory – the skin of the extremities becomes noticeably less sensitive, pain appears.
3. Motor – there is a noticeable impairment of reflex-motor function.
4. Mixed - the patient experiences symptoms of motor and sensory forms of the disease simultaneously.
5. Pseudotabetic - movements are highly uncoordinated.
6. Autonomic – pathology affects the cells of the autonomic nervous system, which regulates the activity of the entire organism. As a result, disturbances in the functioning of blood vessels, glands, and internal organs appear.

Polyneuropathy of the lower extremities

Most often, the pathology affects the lower extremities. They are more vulnerable due to the significant load, so the disorders progress faster and the symptoms appear more pronounced. Without appropriate treatment, the disease can lead to severe consequences. There are often cases when a person’s legs fail due to prolonged alcohol abuse.

Lower limb failure

With distal polyneuropathy of the lower extremities, the foot and the surrounding area usually suffer. The proximal form affects the area of ​​the legs located above.

The disease is classified according to its cause:

• toxic polyneuropathy of the lower extremities - the cause is the use of toxic drugs (arsenic, mercury, lead), sometimes the disease is provoked by taking antibiotics;
• dysmetabolic polyneuropathy of the lower extremities - occurs under the influence of substances that are produced in the body due to the development of certain pathologies and are carried through the bloodstream;
• diabetic – develops in patients with diabetes;
• alcoholic – the cause of the disease is prolonged consumption of large doses of alcohol.

Polyneuropathy of the upper extremities

Diseases of the upper extremities most often occur due to the use of alcohol and chemical substances. Pathologies of the kidneys, liver, pancreas, as well as vitamin deficiency and various infections can also be the cause. Alcoholic neuropathy of the upper extremities is most often observed in long-term alcoholics.

Symptoms of alcoholic polyneuropathy

Symptoms of neurological syndrome caused by alcohol intoxication largely depend on the form of the disease. Polyneuropathy is manifested by dysfunction of the nervous system. If the pathology affects the cells of the peripheral nervous system, either a sensory, motor, or mixed variety develops. Damage to neurons in the brain or spinal cord leads to the development of a vegetative form of the disease.

Alcoholic polyneuropathy is accompanied by symptoms such as:

• swelling of the feet, hands, joints;
• decreased sensitivity and reflexes;
• memory impairment, temporary lapses;
• mental disorders;
• dysfunctions of the respiratory system, cardiovascular system, internal organs;
• damage to the oculomotor nerve, blurred vision.

Often, after taking a large dose of alcohol, the patient’s arms go numb or his legs are paralyzed.

Common signs of neuropathy

Due to the fact that many small nerves are damaged during neuropathy, the following symptoms appear:

• the muscles of the arms and legs lose strength (the process begins with the feet and hands, gradually moving to the entire limb);
• loss of reflexes;
• unusual sensations in the limbs - burning, tingling, goosebumps;
• severe unreasonable pain;
• involuntary muscle twitching, trembling of fingers;
• increased sweating, independent of ambient temperature and physical activity;
• increased heart rate, shortness of breath, shortness of breath;
• dizziness, problems with balance and coordination.

Problems with coordination

The disease can develop very quickly or progress gradually over several months.

Subclinical form

At the initial stage of development, clinical signs of polyneuropathy practically do not appear. The disease can only be detected through instrumental research. Possible loss of sensitivity in the limbs and deterioration of fine motor skills. When pressing in certain places (where the nerve passes), pain occurs.

Motor form

This type of neuropathy is characterized by weakening of muscles, decreased motor ability, the occurrence of partial paralysis, and the appearance of sensory disturbances (strange sensations in the limbs, weakening and increased sensitivity).

In the motor form of the disease, disturbances in the functioning of the extensor muscles are observed, muscle volume and tone decrease. A person’s gait changes, he walks on his toes.

Sensory form

In the sensory form of the disease, the lower extremities are most often affected. Observed:

• cramps in the calf muscle;
• itching and tingling in the legs (or arms);
• feet (or hands) are constantly cold;
• muscles weaken, legs (or arms) begin to go numb;
• tendon reflexes decrease;
• in the feet (or hands) sensitivity to pain and temperature changes disappears or increases.

Signs of the sensory form are often combined with autonomic and motor disorders. Sweating increases, the skin on the feet and hands becomes bluish. Sometimes trophic ulcers form.

Pseudotabetic form

The patient develops specific disturbances in coordination of movements and gait, as well as disorders of muscle-joint sensitivity. When palpating the area where the nerve fibers lie, a sharp, severe pain occurs. Despite the fact that the clinical picture of the disease is similar to tabes dorsalis, the lumbago characteristic of this disease is absent.

Vegetative form

The vegetative form is characterized by disorders of the reflex functions of blood vessels, glands, and internal organs. Most often, the pathology affects the cardiovascular, circulatory and genitourinary systems.

Symptoms of autonomic polyneuropathy:

• frequent dizziness, loss of consciousness;
• visual disturbances – dots flashing before the eyes;
• decrease in pressure when changing posture;
• heart rhythm disturbances;
• prolonged nausea, vomiting;
• heavy sweating;
• indigestion, diarrhea;
• urinary incontinence;
• decreased libido in men and women;
• erectile disfunction.

In other forms of the disease, vegetative signs may also appear.

Symptoms

Alcoholic neuropathy of the lower extremities initially has symptoms in the form of weakness in the lower leg muscles. However, this symptom is used to characterize a number of other diseases and simply physical fatigue. Therefore, most people do not pay attention to the primary manifestations of the pathology and begin treatment in the later stages of its development.

The following symptoms indicate polyneuropathy of the lower extremities:

• increased or decreased skin sensitivity;
• dryness and flaking of the skin;
• change in gait;
• the skin takes on a blue or marbled tint;
• changes in blood pressure;
• burning pain;
• delamination of nail plates;
• hair loss.

Damage to the peripheral nervous system manifests itself in the form of a sensation of “pins and needles” in the lower extremities, partial or complete numbness. This symptom is complemented by muscle cramps. And the intensity of pain in the lower body increases with contact or physical activity.

Over time, atrophy of muscle fibers develops, accompanied by the appearance of ulcers on the surface of the skin. In severe cases, symptoms of alcoholic neuropathy are noted in the form of rapid heartbeat, increased sweating, and shortness of breath. These factors indicate lung damage, which requires immediate medical attention.

With acute intoxication of the body, confusion and signs of mental disorders occur. Violations of facial expressions and temporary retention of urination are also possible.

An important feature of alcoholic polyneuropathy is that about a month after the onset of the first signs, relief occurs, but this symptom indicates the transition of the disease to the chronic phase.

If your legs just start to hurt, you need to seek help from a doctor and undergo treatment for alcohol addiction.

Treatment

Treatment of alcoholic polyneuropathy of the lower extremities includes several areas:

• drug therapy;
• physiotherapy (impact on nerve fibers and the spinal cord using electrical impulses, acupuncture, magnetic therapy);
• massage and physical therapy, which allow over time to restore muscle tone and strengthen the body;
• normalization of nutrition, complete abstinence from alcohol.

Massage

For drug treatment of alcoholic neuropathy, the patient is prescribed:

• detoxification drugs (to cleanse the body of toxins);
• non-steroidal anti-inflammatory drugs;
• antispasmodics, antidepressants - to relieve pain;
• vasoactive, vasodilators - to normalize blood supply;
• B vitamins;
• medications that improve neuromuscular conduction;
• nucleotides - to eliminate the excitability of nerve fibers.

In case of liver damage, hepaprotectors are included in the treatment regimen.

Attention! Methods and drugs for the treatment of polyneuropathy of the lower extremities should be selected only by a qualified doctor after a complete examination of the patient.

Forecast

With timely treatment, a reverse progression of the disease and an improvement in the patient’s quality of life are possible. A necessary condition for a favorable prognosis is a complete cessation of alcohol consumption.

According to the results of Western epidemiological studies, in the United States, alcoholic polyneuropathy is found in 25–66% of patients with chronic alcoholism.

In most cases, patients become disabled, acquiring one or another degree of disability, since early access to a specialist in this case is a rare occurrence. An important factor determining the unfavorable prognosis is the patient’s inability to give up alcohol and comply with a long-term medical and protective regime.

Possible complications

The human body functions thanks to the well-functioning nervous system. When nerve cells are damaged under the influence of ethanol toxins, the functioning of all organs is gradually disrupted. Without the use of modern methods of treating polyneuropathy, the disease can lead to the development of complications:

• cerebrovascular accident;
• paralysis of limbs;
• mental disorders;
• renal failure;
• paralysis of the respiratory center;
• mental incapacity;
• death.

At the initial stage, the disease is easily treated, but as the pathology develops, treatment becomes longer and longer, the likelihood of complications is higher, and the prognosis for recovery is less and less favorable.

Prognosis for recovery

Despite the complexity of the disease, with timely initiation of treatment, the prognosis is favorable. It is very important to completely abstain from alcohol and follow all doctor’s orders. Drug treatment, special physical exercises, and massage eventually lead to the restoration of neurons and complete recovery.

Polyneuropathy can be treated over a fairly long period of time. Together with mandatory subsequent rehabilitation, the duration of therapy is about a year.

If the patient continues to drink alcohol or refuses treatment, then paralysis, disability, and subsequently death are possible due to damage to the nerve cells responsible for the functioning of the brain, respiratory and cardiovascular systems.

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