Alcoholic polyneuropathy – multiple damage of peripheral nerves at alcoholism. Usually arises at late stages of an alcoholic disease. Is followed by weakness of muscles, violations of sensitivity and an ataxy. The increased perspiration is possible. Hypostases, changes of temperature and coloring of disteel departments of extremities are quite often observed. In some cases there are mental disorders. Develops gradually, more rare sharply. At treatment symptoms are reduced within several months or years. Vitamin therapy, metabolic therapy and physical therapy is carried out. At refusal of alcohol the forecast rather favorable.
Alcoholic polyneuropathy – the disease which is followed by simultaneous defeat of a large number of peripheral nerves. Statistically, the polyneuropathy accompanied with neurologic symptomatology comes to light at 10-30% of the patients having alcoholism. When carrying out a complex elektromiografichesky research these or those violations demonstrating existence of an asymptomatic form of an alcoholic polyneuropathy come to light at most of chronic alcoholics.
Men suffer from clinical forms of a polyneuropathy more often than women. The chronic or subsharp current is in most cases observed. Sometimes the disease develops sharply, against the background of hard drinking or overcooling. Duration of a disease can significantly differ and makes from several months to several years. The outcome considerably depends on timely treatment and refusal of alcohol intake. The alcoholic polyneuropathy often becomes the reason of disability which in the subsequent can be removed in case of satisfactory results of treatment. Treatment of this disease is performed by neurologists in cooperation with experts in narcology.
Reasons of development and classification of an alcoholic polyneuropathy
Are the main reasons for development of an alcoholic polyneuropathy: toxic effect of alcohol on an organism, shortage of vitamins of group B, violation of food, increase in content of sugar in blood and hereditarily the caused features of metabolism of the patient. Pathology, as a rule, arises at patients with the third, is more rare – with the second stage of alcoholism. The probability of emergence of symptoms of a polyneuropathy increases at the reception of low-quality alcohol, denatured alcohol and various chemical liquids containing ethyl alcohol.
At the constant use of alcohol in an organism of the patient the toxic intermediate product of disintegration of ethanol – ethyl aldehyde collects. It has destructive effect on all bodies and fabrics, including – on axons of nervous cages. Ethyl aldehyde accumulation speed substantially is defined hereditarily by the caused features of metabolism – ability of an organism to produce an atsetaldegiddegidrogenaza and alcohol dehydrogenase (the enzymes participating in ethanol processing).
The situation is aggravated with deficiency of B1 vitamin which participates in transfer of nervous impulses, acts as antioxidant, interferes with destruction of cages (including cells of nervous tissue) and influences processing of alcohol in a liver. Shortage of B1 vitamin is caused by the whole complex of the reasons among which – the insufficient or unbalanced food connected with a loss of appetite, hard drinkings, material difficulties and an inattention to the health; deterioration in absorption of B1 vitamin in intestines; malfunction of cells of a liver etc.
All violations develop gradually, pathological changes in peripheral nervous system arise long before emergence of the first clinical symptoms. Taking into account expressiveness of these changes, and also existence or lack of clinical symptomatology distinguish 4 stages of a polyneuropathy:
- 0 stage – a polyneuropathy is absent. Symptoms of pathology do not come to light even when carrying out special researches (an electromyography, quantitative vegetative and touch testing).
- 1 stage – an asymptomatic polyneuropathy. Clinical signs are absent, however special researches demonstrate existence of pathological changes.
- 2 stage – clinically significant polyneuropathy. The disease can be diagnosed on the basis of complaints and an objective research, the expressed functional defect is absent.
- 3 stage – a polyneuropathy with the expressed functional violations. Working capacity is lowered or lost.
Symptoms and diagnostics of an alcoholic polyneuropathy
Paresteziya – the sensitivity violations which are shown feeling of an easy sleep, crawling of goosebumps and prickings become the first manifestations of an alcoholic polyneuropathy usually. Patients complain that "stayed a leg" at long stay in a sitting position or "have pins and needles in a hand" in a dream. At initial stages of a polyneuropathy of a paresteziya appear only at long stay in an uncomfortable position therefore quite often do not cause special alarm among patients.
In the subsequent the frequency of emergence and expressiveness of paresteziya increases. Temperature and painful sensitivity decrease, the sleep becomes constant and gradually extends in the proximal direction. Patients with the expressed polyneuropathy say that the gloves and socks reducing sensitivity are put on their hands and legs as if. When walking the feeling of the movement "on the airbag" is created. During the work as hands objects are badly perceived to the touch. The symptom can progress as also more is sharp (approximately within a month), and gradually (within a year).
Paresteziya can be combined with the progressing muscular weakness which also extends in the ascending direction. In certain cases in a clinical picture muscular weakness prevails, and paresteziya pass into the background. Touch and muscular violations in the lower extremities come to light practically at all patients. The top extremities are involved in process approximately in 50% of cases. At defeat of the thick fast-carrying-out nervous fibers not only temperature and painful, but also vibration sensitivity, and also musculoarticulate feeling suffers. In hard cases there are paralyzes.
At neurologic inspection at early stages increase in tendinous reflexes, on late – decrease comes to light. Skin and painful sensitivity is reduced. The tone of muscles is lowered, in the presence of muscular violations the atrophy quickly develops. Sometimes in disteel departments of extremities contractures are formed. The damage of gastrocnemius muscles which is followed by strengthening of pain at a palpation of muscles and pressure upon the field of passing of the nerves innervating this anatomic area is often observed. As the additional method allowing to confirm the diagnosis of a polyneuropathy use an electromyography, quantitative vegetative and touch testing.
Treatment and the forecast at an alcoholic polyneuropathy
Treatment includes full refusal of reception of alcoholic drinks and good nutrition. To patients appoint group B vitamins in tablets and injections, antioxidants, antigipoksant, means for improvement of microcirculation and nervous conductivity. At an intensive pain syndrome use analgetics, sometimes – antikonvulsant and antidepressants. Carry out the massage and LFK directed to prevention of contractures and strengthening of the affected muscles.
Important part of treatment is psychotherapeutic work on an explanation of the reasons of development of an alcoholic polyneuropathy and importance of maintenance of a sober way of life. Besides, the psychotherapist helps the patient to cope with the psychological difficulties arising against the background of the termination of reception of alcohol. In need of the patient direct to the narcologist who carries out drug treatment of alcoholism, an implant vshivaniye, coding on Dovzhenko or gipnosuggestivny therapy.
The forecast at a polyneuropathy depends on disease severity, existence or lack of treatment and readiness of the patient to refuse alcohol intake. At the height of a disease the expressed working capacity violations are observed, however in the subsequent manifestations of a polyneuropathy are gradually reduced. In an active phase most of patients becomes disabled II group, in process of improvement of a state they are transferred to the III group. In the subsequent in mild cases perhaps full elimination of symptoms and restoration of working capacity, at other patients are observed the residual phenomena of various degree of expressiveness. Alcohol intake and violations of food at the patients who transferred an alcoholic polyneuropathy can provoke an exacerbation of a disease with development of brighter clinical symptomatology.