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Alcoholic neuropathy

Neuropathy - alcoholic; Alcoholic polyneuropathy

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

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.

Symptoms

Symptoms of this condition include any of the following:

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

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

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

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

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 maintain muscle function and limb position.

Medicines may be needed to treat pain or uncomfortable sensations. People with alcoholic neuropathy have alcohol use problems. They will be prescribed the smallest dose of medicine needed to reduce symptoms. This may 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 help reduce pain.

People with lightheadedness or dizziness when standing up (orthostatic hypotension) may need to try several different treatments before finding one that successfully reduces their 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:

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, social support such as Alcoholics Anonymous (AA), or 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.

When to Contact a Medical Professional

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

Prevention

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

References

Katirji B. Disorders of peripheral nerves. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 107.

Koppel BS. Nutritional and alcohol-related neurologic disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 416.

    • Alcoholic neuropathy

      Alcoholic neuropathy - illustration

      Alcoholic neuropathy is a disorder involving decreased nerve function due to the damage caused by habitual alcohol abuse. The damage may affect the autonomic nerves (those that regulate internal body functions) and the nerves that control movement and sensation.

      Alcoholic neuropathy

      illustration

    • Motor nerves

      Motor nerves - illustration

      Motor nerves are the nerves responsible for all voluntary skeletal and somatic movement such as moving the leg or arm.

      Motor nerves

      illustration

    • Autonomic Nerves

      Autonomic Nerves - illustration

      Autonomic nerves are concerned with muscular functions which are reflexive, such as breathing, heartbeats and peristalsis (rhythmic movements of the intestines).

      Autonomic Nerves

      illustration

    • Central nervous system

      Central nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system

      illustration

      • Alcoholic neuropathy

        Alcoholic neuropathy - illustration

        Alcoholic neuropathy is a disorder involving decreased nerve function due to the damage caused by habitual alcohol abuse. The damage may affect the autonomic nerves (those that regulate internal body functions) and the nerves that control movement and sensation.

        Alcoholic neuropathy

        illustration

      • Motor nerves

        Motor nerves - illustration

        Motor nerves are the nerves responsible for all voluntary skeletal and somatic movement such as moving the leg or arm.

        Motor nerves

        illustration

      • Autonomic Nerves

        Autonomic Nerves - illustration

        Autonomic nerves are concerned with muscular functions which are reflexive, such as breathing, heartbeats and peristalsis (rhythmic movements of the intestines).

        Autonomic Nerves

        illustration

      • Central nervous system

        Central nervous system - illustration

        The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

        Central nervous system

        illustration

      Tests for Alcoholic neuropathy

       

      Review Date: 5/15/2017

      Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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