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Alcoholic neuropathy
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Alcoholic neuropathy

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Neuropathy - alcoholic; Alcoholic polyneuropathy

Alcoholic neuropathy is damage to the nerves that results from excessive drinking of alcohol.

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  • Causes

    The exact cause of alcoholic neuropathy is unknown. It likely includes both a direct poisoning of the nerve by the alcohol and the effect of poor nutrition associated with alcoholism. Up to half of long-term heavy alcohol users develop this condition.

    In severe cases, nerves that regulate internal body functions (autonomic nerves) may be involved.

    Risks of alcoholic neuropathy include:

    • Long-term, heavy alcohol use
    • Alcoholism that is present for 10 years or more
  • Symptoms

    • Numbness in the arms and legs
    • Abnormal sensations, such as"pins and needles"
    • Painful sensations in the arms and legs
    • Muscle weakness
    • Muscle cramps or muscle aches
    • Heat intolerance, especially after exercise
    • Impotence (in men)
    • Problems urinating, incontinence (leaking urine), feeling of incomplete bladder emptying, difficulty beginning to urinate
    • Constipation
    • Diarrhea
    • Nausea, vomiting

    Additional symptoms that may occur with this disease:

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

    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 usually develop gradually and become worse over time.

  • Exams and Tests

    Your health care provider will perform a physical exam and ask about your symptoms. An eye exam may show eye problems.

    Alcoholism often makes your body unable to use or store certain vitamins and minerals. Blood tests will be ordered to check for a deficiency (lack of):

    • Thiamine (vitamin B1)
    • Pyridoxine (vitamin B6)
    • Pantothenic acid and biotin
    • Vitamin B12
    • Folic acid
    • Niacin (vitamin B3)
    • Vitamin A

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

    • Electrolyte levels
    • Electromyography (EMG)
    • Liver and kidney function tests
    • Thyroid function tests
    • Levels of vitamins and minerals in the body
    • Nerve conduction tests
    • Nerve biopsy
    • Upper GI and small bowel series
    • Esophagogastroduodenoscopy (EGD)
    • Voiding cystourethrogram
  • Treatment

    Once the alcohol problem has been addressed, treatment goals include:

    • Controlling symptoms
    • Maximizing ability to function independently
    • 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 needed to make sure muscle function and limb position are maintained.

    Medicines may be needed to treat pain or uncomfortable sensations. Because persons with alcoholic neuropathy have alcohol dependence problems, they are advised to take the least amount of medicine needed to reduce symptoms to help prevent drug dependence and other side effects of chronic use.

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

    Light-headedness or dizziness when standing up (orthostatic hypotension) may require several different treatments before finding one that successfully reduces symptoms. Treatments that may help include:

    • Wearing compression stockings
    • Eating extra salt
    • Sleeping with the head elevated
    • Using medicines

    Bladder problems may be treated with:

    • Manual expression of urine
    • Intermittent catheterization (male or female)
    • Medicines

    Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms often respond poorly to treatment in people with alcoholic neuropathy.

    It is important to protect body parts with reduced sensation from injury. This may include:

    • Checking the temperature of bath water to prevent burns
    • Changing footwear
    • Frequently inspecting the feet and shoes to reduce injury caused by pressure or objects in the shoes
    • Guarding the extremities to prevent injury from pressure

    Alcohol must be stopped to prevent the damage from getting worse. Treatment for alcoholism may include counseling or social support such as Alcoholics Anonymous (AA), or taking medicines.

  • Outlook (Prognosis)

    Damage to nerves from alcoholic neuropathy is usually permanent. It is likely to get worse if the person continues to use alcohol or if nutritional problems are not corrected. Alcoholic neuropathy is usually not life-threatening, but it can severely affect quality of life.

  • Possible Complications

    • Disability
    • Long-term (chronic) discomfort or pain
    • Injury to extremities
    • Falling, especially at night
    • Urinary incontinence or retention
  • When to Contact a Medical Professional

    Call for an appointment with your health care provider if you have symptoms of alcoholic neuropathy.

  • Prevention

    The only way to prevent alcoholic neuropathy is not to drink alcohol.

Related Information

  BeriberiAlcoholism and alc...     Alcoholism

References

Chopra K, Tiwari V.  Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012;73: 348-362.

Katri B, Koontz D. Disorders of the peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 76.

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Review Date: 5/28/2013  

Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles CA; Department of Surgery at Los Robles Hospital, Thousand Oaks CA; Department of Surgery at Ashland Community Hospital, Ashland OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne WY; Department of Anatomy at UCSF, San Francisco CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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