Alcoholic neuropathy

Definition

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

Alternative Names

Neuropathy - alcoholic; Alcoholic polyneuropathy

Causes, incidence, and risk factors

The cause of alcoholic neuropathy is debated. It probably includes both a direct poisoning of the nerve by the alcohol, and the effect of poor nutrition associated with alcoholism.

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

Risks for 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; "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
• Problems with movements

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 usually develop gradually and slowly become worse over time.

Signs and tests

Your doctor will get an extensive description of the problem and will perform a neurological exam. Signs may include:

• Weakness
• Numbness to touch
• Loss of reflexes (such as the knee jerk)

Neurological problems usually affect both sides of the body in this condition.

An eye exam may show decreased pupil response or other problem. Blood pressure may fall when you stand up.

Alcoholism often causes nutritional deficiency. This is because people drink excessively instead of eating properly, and because some vitamins and minerals are used up or lost due to the alcohol. 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

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

• Serum electrolyte levels
• Studies of kidney and liver function
• Thyroid function tests
• Levels of vitamins and minerals in the body
• Nerve conduction tests
• Electromyography (EMG)
• Nerve biopsy
• Upper GI and small bowel series
• Esophagogastroduodenoscopy (EGD)
• Isotope studies of gastrointestinal function
• Voiding cystourethrogram

Treatment

Once the immediate 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 maximize muscle function and maintain limb position.

Patients may take medication, if necessary, to treat pain or uncomfortable sensations. The response to medications varies. Patients are advised to take the least amount of medication needed to reduce symptoms, to help prevent drug 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. Tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine may help stabbing pains.

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

Some people may need to treat blood pressure problems, difficulty with urination, and slow gastrointestinal movement.

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

• Wearing elastic stockings
• Eating extra salt
• Sleeping with the head elevated
• Using medications such as fludrocortisone

Bladder dysfunction may be treated with:

• Manual expression of urine
• Intermittent catheterization
• Medications such as bethanechol

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

Stop using alcohol to prevent the damage from getting worse. Treatment for alcoholism may include psychiatric therapy social support such as Alcoholics Anonymous (AA), medications, and behavior modification.

Expectations (prognosis)

Damage to nerves from alcoholic neuropathy is usually permanent and may get worse if you continue to use alcohol or do not correct nutritional problems. Symptoms vary from mild discomfort to severe disability. The disorder is usually not life-threatening, but it may severely affect your quality of life.

Complications

• Disability
• Long-term (chronic) discomfort or pain
• Injury to extremities

Calling your health care provider

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

Prevention

Avoid or minimize alcohol use. Avoiding alcohol entirely is the safest treatment for persons with alcoholism.

References

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.