Alcoholic polyneuropathy is exacerbation of chronic alcoholism, which occurs most often. It appears in the vast majority of people who for a long period are dependent on chronic alcoholism.
The clinical symptoms of this disease were first explained in the 18th century by the English physician and philanthropist John Coughley Letts in 1787.
Causes of development of alcoholic polyneuropathy
The basis of the disease is, by and large, axonal degeneration. Less often degrades the myelin sheath.
Axonal degeneration is expressed by the direct influence of toxic metabolites of alcohol on nerve fibers and the lack of vitamins of group B (mainly thiamine). Myelin sheath is affected because of the poor and not diverse nutrition of the patient, and in addition, the deterioration of the ingestion through the skin of vitamin B due to gastroenteritis. At the same time, the impact of other causes, including, genetic, autoimmune, age, and so on, is also possible.
Symptomatic of the disease
Alcoholic polyneuropathy is nothing more than symmetrical sensorimotor neuropathy. The initial symptoms may be a slight weight loss of the leg muscles, a decrease and loss of the Achilles tendon and knee reflexes. After that, the symptoms are supplemented with paresthesia, hyperesthesia. They are adjoined: hyperpathy, numbness, pain in the feet, painful cramps in the calf muscles. Sometimes patients have allodynia. Partial paralysis of the muscles of the forearm of the posterior group (extensor of the fingers) and the muscles of the anterior tibia (extensor of the feet) often develops slowly. The malaise in the feet provokes a change in the gait according to the principle of "steppeage". Over time, this symptomatology passes to the proximal zones of the legs, with complications - to the distal zones of the hands and lower areas of the trunk. The disease develops slowly over long months, sometimes even years.
Diagnosis of the disease
During the examination, the degree of slimming of the muscles of the legs and feet is determined, and the pain and temperature perception in the distal zones of the extremities (on the principle of "gloves" and "socks") are reduced. There are frequent cases of diagnosis and other types of anesthesia.
In the overwhelming majority of patients, the Achilles reflexes are underestimated or lost, in half of patients, the knee reflex is worsened or completely deprived, in rare cases - reflexes on the hands. There are cases of a painful condition when palpation of the nerve trunks and muscles with the fingers. Diagnostic vegetative changes - distal hyperhidrosis, trophic changes in the skin and nails, swelling and excessive accumulation of pigments, a change in the skin tone. Do not exclude a violation of pupillary reaction, orthostatic hypotension, interruptions in urination, impotence, upset gastrointestinal tract.
Instrumental diagnostic methods
In the case of a subclinical course of alcoholic polyneuropathy, it is recommended to conduct needle electroneuromyography. With the help of histological examination, the features of distal fracture of axons and secondary myelinopathy are determined.
Methods of treating the disease
It is suggested to abandon alcoholic beverages, giving preference to full-fledged, coordinated nutrition. It is recommended to administer thiamine together with additional vitamins of group B, as well as means to improve microcirculation and give the opportunity to have a metabolic effect. An adequate solution will be to begin therapy of the disease by administering thiamine by injection (2-4 ml of a 5 percent drug intramuscularly).
Following the onset of relief, 100 mg is given twice or thrice a day. If there are additional destructive effects on the liver, alpha-lipoic acid (espolipon) is administered parenterally (600 mg by drop, every day, or 20 alternations every other day), then inside 600 mg for 30-60 days. It is recommended that physical measures be taken to prevent contractures and restore muscle.