Alcoholic neuropathy. Complications of the disease, prognosis. it occurs only with prolonged use of ethyl alcohol
Alcoholic polyneuropathy is one of the many reactions of the body to prolonged abuse of alcohol-containing drinks, including surrogates. ethyl alcohol. ICD 10 disease code (international classification) - G62.1.
Once in the body, alcohol toxins affect the muscles (myopathy occurs), cause signs of liver cirrhosis; memory disorders are also observed, which are expressed in Korsakov's syndrome, degeneration of the cerebellum occurs.
However, in addition to these consequences, alcohol abuse causes damage to numerous nerve fibers of the peripheral nervous system, resulting in the development of alcoholic neuropathy.
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Everyone saw patients with chronic alcoholism. This is with thin arms and legs, with cyanosis skin on the hands and feet, specific changes in the face, and also with an uncertain march. All of these signs characterize alcoholic polyneuropathy in its most advanced stage.
According to official statistics, this disease occurs in all people suffering from chronic alcoholism. It was previously believed that only 70% of them are prone to neuropathy, but this was due to the imperfection of diagnostic methods.
In particular, the doctors did not have the opportunity to do electroneuromyography. The symptoms themselves often appear after a long period of time.
Causes
Damage to the fibers of the peripheral nervous system, which causes alcoholic polyneuropathy lower extremities, mainly provoked by 2 reasons:
With the constant use of alcoholic beverages, malfunctions occur gastrointestinal tract. They are expressed in hepatitis, gastritis, pancreatitis with a concomitant deterioration in the absorption of food and, in particular, B vitamins, which are necessary for normal functioning nervous system.
Irregular and poor-quality nutrition, typical for patients with chronic alcoholism, aggravates the situation, provoking the development of a lack of vitamins. When their deficiency reaches a critical level, the nutrition of the nerve conductors deteriorates. As a result, there are violations in their work.
The degree of severity of alcoholic neuropathy is directly affected by the amount of alcohol consumed. The larger it is, the stronger both the toxic effect on the body and the lack of vitamins.
The very concept of a “large dose” of alcohol is ambiguous and may vary depending on a particular person, since each body contains a certain amount of enzymes for the breakdown of ethyl alcohol: some have more of them, some have less.
Thus, for some, it is enough to drink a little alcohol every day to become chronically addicted, while for others, this requires daily consumption of half a liter of alcohol or more.
Both the toxic effects of alcohol and the deterioration in the absorption of B vitamins lead to the destruction of the axon - the base of the nerve fiber. This pathology is called axonal degeneration. Then the myelin covering the nerve fiber is affected, resulting in demyelination.
Both processes provoke a blockage of nerve impulses coming from the affected fiber to the muscles, blood vessels, glands. Pathological changes begin to occur in these structures, which is expressed in characteristic symptoms.
How the disease progresses
Chronic alcoholism is accompanied by a whole bunch of disorders of the psyche and physiology. However, the patient himself cannot objectively assess the violations that occur in his body.
When the toxins in alcoholic beverages long time poison the peripheral nervous system, many pathological changes begin to occur in it:
- violated metabolic processes;
- loss of sensitivity nerve endings;
- deterioration of nerve conduction in the muscles.
Symptoms of alcoholic neuropathy are experienced by up to a third of chronic alcoholics, and men are more often ill. In all the rest, the disease is asymptomatic, as evidenced by the results of complex electroneuromyographic studies.
In most cases, the disease proceeds in a chronic form, less often in a subacute one. Acute alcoholic polyneuropathy develops as a result of alcoholic excess, which causes prolonged use of alcohol in excessive quantities.
Symptoms of alcoholic neuropathy
Signs of alcoholic neuropathy do not manifest themselves immediately, and at first the disease is asymptomatic.
However, gradually the damage to the peripheral nervous system intensifies and a number of symptoms begin to appear:
- burning and shooting pains in the legs;
- paresis;
- itching, burning, tingling in the feet and calves.
All symptoms are present during the day, and at night they increase, preventing good rest. The pain syndrome also becomes brighter with any touch; it becomes difficult for the patient to put on shoes, which causes irritation. As the disease progresses, the pain becomes less severe. This indicates that the nerve fiber has completely collapsed.
Since the nerve fibers responsible for sensitivity are damaged, the patient's temperature perception is disturbed.
Lesions of vegetative fibers lead to trophic disorders, including:
- dryness and peeling of the skin of the legs;
- hyperpigmentation;
- ulcers;
- thickening and stratification of nails;
- hair loss;
- cyanosis of the feet;
- cold skin.
Usually all or almost all signs of the disease are present at once. First, sensitivity decreases, then trophic disorders appear, and in advanced cases- motor. All pathological conditions symmetrical: if any change has occurred on the left leg, then in the same form it is present on the right.
Pathological changes motor fibers lead to muscle weakness and atrophy, and these symptoms spread from the bottom up: at first, flexion and extension of the feet is difficult, then weakness begins to be felt in the calves and thighs. The patient's legs become thinner.
It becomes impossible for the patient to walk on his own and has to rely on something, his motor reflexes in his knees deteriorate, which gradually completely disappear. The muscles themselves become flabby and lose their tone.
Although at first the lesion affects the legs, later it spreads to the arms. With a long course of the disease, a person often ceases to control the functions of the pelvic organs.
In very rare cases neuropathy is a sign of alcoholic polyneuropathy optic nerve, or in another way, alcoholic amblyopia. It develops over several weeks, causing a gradual decrease in vision. Left untreated, it can lead to blindness.
Diagnostics
When making a diagnosis of alcoholic polyneuropathy, doctors around the world adhere to one principle: it is necessary to detect damage to at least one muscle and two fibers of the peripheral nervous system. When examining a patient, violations of motor and autonomic functions, as well as sensitivity, should be detected.
It is also important to confirm the fact that it was precisely alcohol factor. Alcohol addicts always deny their addictions, while neuropathy can be caused by many reasons besides alcoholism.
Another common diagnostic method is electroneuromyography, which can detect those nerve lesions that are asymptomatic.
Treatment
In alcoholic polyneuropathy, conservative treatment. In this case, the patient must comply with 2 important conditions:
- complete rejection of the use of ethyl alcohol and its surrogates;
- transition to full balanced diet.
Only if these conditions are met, the doctor proceeds to further therapy.
Preparations
Treatment for alcoholic neuropathy involves complex therapy medications, among which:
- antioxidants;
- vasoactive drugs;
- vitamins, especially group B;
- hepatoprotectors, cerebral gangliosides and nucleotides - in violation of liver functions;
- antidepressants and anticonvulsants - to relieve pain;
- neurotropic drugs.
Non-drug
No method of treatment for alcoholic neuropathy will work if the patient does not give up alcohol completely. The next step should be to review the usual diet.
It should include more fresh fruits and vegetables, dairy products, cereals, fish and meat products. In order to restore the functions of the digestive tract, it is important to eat soups.
If the disease is still initial stage, physiotherapeutic procedures, massage and therapeutic exercises will be useful. These techniques will help restore muscle tone and sensation in the legs and arms.
Folk remedies
Treatment with herbs and other drugs also demonstrates its effectiveness in alcoholic neuropathy. folk remedies. However, they can only be used in combination with the methods of official medicine and only with the permission of the attending physician.
| Egg and carrot cocktail |
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| Kefir with herbs and seeds |
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| Coniferous baths |
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Complications and consequences
If left untreated, alcoholic neuropathy soon leads to a series of serious complications, among which:
- paresis and paralysis;
- dyspnea;
- tachycardia;
- amnesia;
- disorder of orientation in space;
- loss of sensation in the calves of the legs;
- loss of reflexes from the hands and feet.
First of all, violations of motor functions develop. The muscles responsible for flexion and extension of the feet are affected, as a result of which a person acquires a characteristic gait.
Soon after, the first signs of atrophy of the calf muscles appear, and the legs quickly lose weight. Later, the same thing begins to happen with the muscles. upper limbs. Since the sensitivity in the calves is disturbed, the patient has a feeling that the floor under him has become soft.
There are also changes in the condition of the skin: on the arms and legs, it acquires a bluish tint, it becomes dry. Patients begin to sweat more, they have baldness of the legs, swelling, brittle nails. After some time, the body is covered trophic ulcers.
All signs develop rapidly, and in a short period of time the mobility of patients is significantly limited.
It is important to distinguish between alcoholic and diabetic polyneuropathy, which are accompanied by somewhat similar symptoms. Accurate Diagnosis in this case, only a qualified doctor can put it on the basis of the anamnesis and the performed hardware diagnostics.
Prevention
Any disease is easier to prevent than to cure - this statement also applies to alcoholic polyneuropathy.
As preventive measures, the following are distinguished:
- a balanced diet rich in vitamins and nutrients;
- complete rejection of alcoholic beverages;
- timely treatment of diseases;
- treatment in a sanatorium.
Equally important is a complete balanced diet, which will allow the nervous system to receive B vitamins in the amount that is sufficient for normal functioning.
Alcoholic neuropathy - serious illness which can have serious health consequences. When the patient does not want to be treated, there is no chance of recovery, and his condition will only worsen. However, if a person pulls himself together and realizes the severity of the possible consequences for the body, the prognosis for him will be favorable.
When a person has long been an alcoholic, then against the background of constant alcohol consumption, a dangerous disease begins to develop - alcoholic polyneuropathy. This happens because any alcohol is very toxic, it leads to a violation of metabolic processes and the transmission of impulses. Pathological changes can affect various departments in the brain and spinal cord.
Causes of alcoholic polyneuropathy
Polyneuropathy from constant alcohol use will develop only on final stages alcoholism. The causes of the disease are as follows:
If a person consumes not store-bought, but surrogate alcohol, then the risk of the onset of the disease increases several times. This is due to chemical alcohol-containing liquids and denatured alcohol.
These fluids have a serious effect on the liver, due to which the B vitamins are destroyed almost instantly. Because of this, metabolic disorders are observed.
Symptoms of alcoholic polyneuropathy
In view of the fact that the development of alcoholic polyneuropathy is based on a combination of several causes, the disease is very variable in terms of the clinical picture.
Among the main symptoms of the disease are:
Symptoms of alcoholic polyneuropathy, regardless of their origin, are explained by the simultaneous defeat of a smaller or more peripheral nerves. The predominance of one or the other clinical signs will depend on the damage to the particular type of nerve fibers that make up the peripheral nerve. This nerve consists of thick and thin fibers. All motor fibers are thick myelinated fibers. Vibrational and proprioceptive (deep) sensitivity is also conducted along myelinated fibers. Temperature and pain sensations are transmitted through unmyelinated fibers and thin myelinated fibers. The transmission of tactile sensation is carried out by thin and thick fibers at the same time. Vegetative fibers are thin unmyelinated.
With the defeat of thin fibers, a selective loss of temperature or pain sensitivity usually occurs. Spontaneous pains, paresthesias also occur (even with a normal reflex). Thick fiber neuropathy will usually be accompanied by areflexia, muscle weakness, and sensitive ataxia. Damage to autonomic fibers is usually the cause of somatic symptoms. If all fibers are involved, then mixed (vegetative and sensorimotor) polyneuropathy is observed.
Manifesting symptoms, in most cases, are two clinical patterns: symmetrical motor-sensory and symmetrical sensory polyneuropathy. In the first stages of the disease, there is a predominance of impaired proprioceptive sensitivity. Alcoholics in this case complain of pressing pains in the calf muscle. In this case, primary axonal degeneration, as well as secondary demyelination, acts as a morphological substrate of the lesion.
Neurophysical studies clearly show that two types of nerve fibers can usually be affected (thick and thin), but lesions can also be isolated (only thin or only thick). This may explain the diversity of the clinical picture of alcoholic polyneuropathy. Scientists have not yet found any relationship between the type of affected fibers and the clinical specifics of alcohol abuse.
There is an opinion that the specificity of the clinical picture may largely depend on the level of participation of additional mechanisms in the pathological process. Including thiamine deficiency. In the study of non-alcoholic neuropathy in the presence of thiamine deficiency and alcoholic neuropathy without this deficiency, it shows significant differences between these two conditions. Thiamine-deficient non-alcoholic neuropathy is usually characterized by a rapid onset, rapid progression, and clinical dominance of motor disturbances, in combination with symptoms of superficial and deep sensory damage.
On the other hand, alcohol without thiamine deficiency progresses rather slowly. In this case, the dominant symptom is a violation of superficial sensitivity in combination with severe pain. A biopsy of the sural nerve shows abundant damage to the axons of thin fibers, especially in the early stages of the development of alcoholic polyneuropathy. The last stages of the disease can be characterized by the processes of fiber regeneration.
In thiamine-deficient non-alcoholic neuropathy, thick fiber axons will be damaged. In this disease, there is also much more subperineural edema, but, at the same time, segmental demyelination and further remyelination are very often observed in alcoholic polyneuropathy without thiamine deficiency. Thiamine-deficient alcoholic polyneuropathy exhibits the usually variable combination of symptoms that are characteristic of thiamine-deficient neuropathy. From the above, it can be concluded that clinical picture is formed largely on the basis of concomitant thiamine deficiency.
The diagnosis of the disease is legitimate in case of detection of electrophysiological changes. They must occur in two nerves and a muscle in combination with subjective symptoms (patient complaints) as well as objective manifestations of the disease (neurological status information). At the same time, another etiology of polyneuropathies should be excluded, and anamnestic data from the patient or his relatives about alcohol abuse should be obtained.
Early diagnosis of alcoholic polyneuropathy
Electroneuromyography is the main method that allows you to confirm the diagnosis of the disease. This method is based on the detection of bioelectrical activity, uncharacteristic of neuromuscular fibers.
A fiber biopsy is performed in case of a difficult diagnostic case. This type of study is used in cases where it is required to exclude another subtype of polyneuropathy (uremic, diabetic).
It is very important that the patient does not hide episodes of constant drinking from the attending physician, because this can lead to an incorrect diagnosis. Therefore, the treatment in this case will be wrong.
Prognosis of alcoholic polyneuropathy
Symptoms of the disease without proper treatment will grow. For the patient, this usually ends in various mental disorders, paralysis of the limbs, damage to the cerebellum, in which functional disorders of coordination of movements can be observed.
It is not so difficult to treat polyneuropathy, which will be detected in the first stages. The symptoms of the disease may develop in reverse side, but if the patient returns to drinking alcohol, then the disturbances and signs will also return.
It is important here not to start the disease, otherwise it will lead to irreversible consequences. At this stage, it is very important to stop taking alcoholic beverages, as well as begin to lead an active lifestyle, which will help the body regain lost strength.
Features of the treatment of alcoholic polyneuropathy
If the correct health care, then the prognosis for people who suffer from alcoholic neuropathy is very good. The main condition for positive rehabilitation is the refusal to take alcoholic beverages, as well as a balanced and nutritious diet.
During treatment, efforts must be directed to restoring the lost functions of the body. Treatment should be carried out taking into account the vulnerability of the body in terms of neuropathy, which developed along with the disease. Any omissions cause subsequent damage.
The patient should not take strong painkillers. The frequency of taking pain medication should be limited so that the person does not develop drug dependence.
Given the fact that the patient is deficient in many nutrients, are attributed to him nutritional supplements and vitamins that help the body recover in a particularly difficult conditions. Drugs of this type will eventually level out the signs of the disease, as a result of which their spread will stop.
Due to the loss of skin sensitivity, patients will need to carefully control their thermoregulation, protecting themselves from hypothermia.
Medications for alcoholic polyneuropathy
Therapeutic measures in the treatment of alcoholic polyneuropathy should be aimed at eliminating the toxic effects of alcohol. With the help of antioxidant therapy, a person's condition improves. Therapy is carried out using the following drugs:
- Preparations with lipoic acid (thioctacid, thiogamma, octolipen, berlition);
- Drugs with a vasoactive effect (pentoxifylline, halidor);
- Vitamins (mostly of group B): berocca, benfogamma, milgamma, milgamma compositum, benfolipen, compligam B, etc.;
- Glucose to correct it in the patient's blood.
Due to the fact that alcoholic polyneuropathy is usually also caused by liver damage, the use of hepatoprotective drugs is necessary. Clinical efficacy on high level is found in nucleotides (cytidine, uridine), as well as in cerebral gangliosides, which improve the excitability of peripheral nerve fibers and facilitate reinnervation processes.
Usually symptomatic treatment is aimed at eliminating pain using combilipene, milgamma, compligam B with thiamine content. Anticonvulsants and antidepressants also prove their effectiveness in this case.
Patients who have peripheral paresis are recommended physical exercises, massage, therapeutic exercises, which can strengthen muscles and prevent the development of contractures.
Psychological support of the patient often plays a very important role. The patient needs to explain and justify the causes of the disease, as well as the possibility of obtaining a positive effect from the complete refusal of alcohol intake and the fulfillment of the prescription of the attending physician.
Patients who suffer from alcoholic polyneuropathy should understand that this disease must be treated without fail, even if they are completely absent. neurological symptoms. Otherwise, encouraging forecasts can not wait.
When drinking becomes dangerous habit, the body sends a clear signal. chronic poisoning becomes the cause of a disease such as alcoholic polyneuropathy or disruption of the peripheral nerves, so among patients there are frequent complaints of unpleasant tingling in the limbs or the appearance of goosebumps. The degree of spread of this disease is very high, in the initial stages it can be treated, otherwise it threatens with problems with breathing, heart function and limited mobility.
What is alcoholic polyneuropathy
The long-term toxic effects of alcohol do not go unnoticed for the addicted person. All body systems are negatively affected. From the interconnected nervous structures reaction to the systematic use of alcohol is the appearance of dangerous disease. Alcoholic polyneuropathy is a disease that causes chronic alcohol abuse, which leads to disruption and pathological changes in metabolic processes.
Alcoholic polyneuropathy code according to ICD 10
Reduced sensitivity of nerve endings is the result of prolonged use of alcoholic beverages. The toxic effect of alcohol provokes the development of pathological changes in the metabolic processes of nerve fibers. Since the disease is spread all over the world, and certain methods are used for its treatment, according to international rules, it has a certain labeling. The code for alcoholic polyneuropathy according to ICD 10 is G 62.1, behind these symbols is the name of the disease of the same name, which is characterized by a violation of the functions of peripheral nerves.
Symptoms of polyneuropathy
Toxic neuropathy or atrophy of the muscles of the limbs makes itself felt gradually with a slight numbness and tingling sensation. The first symptoms of polyneuropathy do not cause much concern for some time, but if the development of a neurological disease is not stopped and the fight is not started, this will inevitably lead to paralysis of the legs and speech disorder. The main signs of toxic polyneuropathy are as follows:
- muscle tension, slight numbness of the extremities;
- weakness in the legs;
- convulsions;
- excessive sweating;
- cyanosis of hands, feet;
- speech disorder;
- dry skin, the appearance of sores;
- burning sensation;
- disorientation.
Causes of polyneuropathy
The appearance of such disorders in the work of the nervous system can provoke other diseases. The clinical picture of the course of the disease is similar, and cause it different reasons polyneuropathy. drug overdose, diabetes, oncological diseases, poisoning with chemicals, epilepsy - this is what can be a source of the development of pathological changes. If it is alcoholic neuropathy, then the following factors contribute to the development of a neurological disease:
- metabolic disorders in nerve fibers;
- prolonged toxic effects of ethyl alcohol;
- liver dysfunction;
- lack of B vitamins;
- prolonged squeezing in a monotonous position in drunkenness;
- the presence of a gene that affects the process of splitting ethanol and the formation of enzymes that have a devastating effect on the entire nervous system of the body.
Forms of alcoholic polyneuropathy
Pathological changes can be asymptomatic, and yet these are rare cases among patients with alcoholism. More often, such forms as chronic (more than a year) and acute (month) are observed, which serve not only as evidence of the presence of the disease, but also as confirmation of the progressive nature of the process. Based on the clinical picture of the disease, in medicine it is customary to distinguish between the following forms of alcoholic polyneuropathy:
- Motor. It is characterized by sensory disturbances ( mild degree), peripheral paresis ( varying degrees), damage to the lower extremities, which accompanies impaired flexion of the fingers, rotation of the foot, and a decrease in the Achilles reflex.
- Sensory. Decreased temperature, pain sensitivity of the limbs, numbness, convulsions, a feeling of chilliness, marbling of the skin, vegetative changes - all this characteristics that indicate sensory disturbances.
- Atactic. It is indicated by a lack of coordination of movements, numbness of the legs, a staggering gait, pain on palpation of the nerve trunks, the absence of a tendon reflex.
- Mixed. It is a combination of motor and sensory disorders, and this manifests itself through numbness, pain, flaccid paresis, paralysis of the upper and lower extremities. This form can be accompanied by such signs as atrophy of the muscles of the forearm, hand, decrease in deep reflexes, hypotension.
Diagnosis of alcoholic polyneuropathy
The main method of confirming the diagnosis is electroneuromyography (ENMG), which is used in the early stages. Diagnosis of alcoholic polyneuropathy in severe cases involves a biopsy of nerve fibers, in addition, this method used when it is necessary to exclude other types of disease: is the polyneuropathy toxic or diabetic? Examination with the help of ENMG helps to find out the severity of the damage, how much the neuron, root, nerve, muscles are affected, but first the neurologist must conduct an objective examination and collect an anamnesis.
Treatment of polyneuropathy
A neurological disease can manifest itself either after long binge, or against the background of gradual toxic effects for a long time. Given these factors, the treatment of polyneuropathy will take place in different directions, but any therapy will affect the complete refusal to drink alcohol, increased attention to nutrition. To improve microcirculation, neuromuscular conduction, pain syndrome, the doctor may prescribe antihypoxants, analgesics, anti-inflammatory drugs, antioxidants, B vitamins.
Treatment of neuropathy of the lower extremities with drugs
It will be easier to achieve a full recovery if the disease is diagnosed in the early stages. Treatment of neuropathy of the lower extremities with drugs is aimed at restoring the functions of nerve fibers, improving blood circulation in the area of nerve endings. The subtlety of therapy is to identify true reasons diseases, taking into account individual characteristics the patient's body, for example, a predisposition to allergic reactions.
To improve the patient's condition, when toxic polyneuropathy of the lower extremities is correctly diagnosed, apply the following types therapy:
- medication with the appointment of a course of vasoactive drugs (Emoxipin, Vasonita, Nicotinic acid, Instenon);
- the use of antidepressants (Mexidol, Actovegin, Sertraline, Berlition, Venlafaxine);
- a course of B vitamins, Benfotiamine, Thiamine to compensate for the deficiency;
- taking non-steroidal anti-inflammatory painkillers (Nimesulide, Ketoprofen, Meloxicam);
- anticonvulsants (Gabapentin, Pregabalin);
- use ointments, creams for local anesthesia(Ketoprofen, Diclofenac, Finalgon, Kapsikam, Capsaicin).
Non-drug methods
To speed up the healing process, other methods of treatment, in addition to taking medications, help. Physiotherapy procedures formed the basis non-drug method treatment of toxic polyneuropathy, among them electrical stimulation of nerve fibers is successfully used, spinal cord, magnetotherapy. Studies prove the effectiveness of massage, which helps restore muscle activity. To the list comprehensive measures worth including physiotherapy exercises, mud therapy, acupuncture.
The combination of drug, non-drug, alternative methods of treatment allows you to achieve excellent results, speed up recovery. A freshly prepared cocktail of kefir (150 grams), parsley, sunflower seeds (2 tablespoons each), which is taken an hour before meals twice a day, will help the treatment. A powerful natural antioxidant - cinnamon - ideally combined with oregano, honey. To prepare useful decoction, you need to take all the components in equal proportions, mix and take 1 teaspoon three times a day with a glass warm water.
Polyneuropathy prognosis
Launched Form diseases or untimely start of treatment leads to disability, so it is necessary to start therapy and determine the treatment regimen on time. A favorable prognosis of polyneuropathy with a possible complete recovery is noted only in those patients who consulted a doctor in a timely manner and underwent a course of therapy. Behind short term it will not be possible to recover from a neurological disease, in order to achieve the desired goal, you will have to persevere, adhere proper nutrition, avoid taking any alcoholic beverages.
Video: Alcoholic polyneuropathy of the lower extremities
Alcoholic polyneuropathy develops in people who abuse alcohol. There is a destruction of peripheral nerves due to the toxic effects of alcohol.
Peripheral nerves suffer five times more often than the central nervous system, the incidence of the disease is approximately 11-13%, however, latent forms of the disease are found in 98% of chronic alcoholics. According to ICD 10, alcoholic polyneuropathy has the ICD code G62.1.
Alcoholic polyneuropathy refers to diseases of the peripheral nervous system. Prolonged use of alcoholic beverages causes intoxication of the body. Metabolism is disturbed in the nerve fibers, a deficiency of nutrients is formed, so the tissues degenerate.
Ethanol recycling requires a large number of thiamine (vitamin B1), therefore, a deficiency of this substance is formed. The nutrition of people who abuse alcohol is usually wrong, with a lack of vitamin B1, in addition, ethanol prevents the normal absorption of thiamine in small intestine. Thiamine is the main "protector" of nerve fibers, prevents their decay, so the lack of a substance negatively affects the peripheral nerves.
Under the influence of acetaldehyde (a breakdown product of ethyl alcohol), the patient's immunity decreases. A huge number of antibodies appear, which begin to inhibit the body's own cells, including nerve cells. Thus, axonopathy is formed in a chronic alcoholic, followed by demyelination. That is, first the nerve processes (axons) are destroyed, then the myelin sheath of the nerves is damaged.
Polyneuropathy should be differentiated from alcoholic neuritis and polyneuritis. The latter differ in that the nerves develop inflammatory process, which is accompanied severe pain. Structural changes in the nerves occur against the background of inflammation. is a non-inflammatory disease.
Causes of pathology
alcoholic polyneuropathy - the toxic effects of ethanol on the nervous system. As a result, the patient develops conditions that are provoking factors for the development of the disease:
- Decreased immunity while the immune system cannot resist bacteria and viruses.
- Nutrient deficiency.
- Development of autoimmune reactions.
- Impaired liver function.
- In many patients, doctors diagnose hereditary vulnerability of the nervous system in relation to various factors, including the effects of alcohol.
Forms and stages of the disease
In medicine there are various classifications alcoholic polyneuropathy. Depending on which nerves are affected, the following forms of pathology are distinguished:
- touch. The patient has loss of sensation in the extremities. The legs are the most affected. Temperature perception changes, limbs freeze in heat, skin integuments turn pale. are declining tendon reflexes, the patient feels numbness of the toes and palms.
- Motor. Characterized by a violation motor activity. The tibial and peroneal nerves. The functions of flexion, rotation of the foot, fingers are impaired, the patient cannot walk on tiptoe. In the area of the feet, the muscles weaken, atrophy.
- mixed. Combines sensory and motor types. Is different flaccid paresis limbs, decreased reflexes, loss of sensation along the main nerves.
- Atactic. The deep sensitivity of the lower extremities is disturbed, therefore, the patient's coordination of movements is disturbed, the lower parts of the legs do not feel anything, the gait changes, there are no knee and Achilles reflexes.
- Vegetative. The autonomic nervous system is affected. The patient develops conditions similar to the manifestations of VVD: tachycardia, pressure surges, sudden sweating, fainting. The pupillary reflex worsens, visual acuity decreases.
- Autonomous. The most severe form, in which the destruction touches the nerves responsible for work internal organs. An alcoholic has a bad heart, kidneys, and bladder.
Another classification of the disease is based on the duration of the course and the severity of the symptoms:
- Sharp form. Pathology develops within a couple of weeks, the manifestations are pronounced.
- Chronic. It develops slowly over the course of a year. The most common form.
- Latent. It is asymptomatic, signs are detected during a detailed examination.
In its development, the disease goes through several stages:
- subclinical. The patient does not feel any changes, signs are found only during neurological examination: a decrease in pain and temperature sensitivity.
- Clinical. First, the patient experiences pain in the affected nerves, then sensitivity worsens, numbness of the fingers or parts of the body begins. Then the pain disappears, there is muscle weakness, difficulty with movement.
- stage of complications. Tissue atrophy occurs, ulcers form on the legs, usually painless. Most often, to save the life of the patient at this stage, amputation of the limb is performed.
What nerves are affected?
First in pathological process the longest nerves are involved: sciatic, tibial, peroneal. The man is experiencing pain in his legs. Smaller nerves take over the functions of larger ones for a while, but over time they also begin to break down.
After structural changes begin in the hands, suffer median, radial, ulnar nerve. With alcoholism, optic neuropathy develops.
It is characterized by visual impairment that progresses quite rapidly and can lead to blindness. The oculomotor, vagus, and phrenic nerves also suffer.
Important: with damage to the phrenic and vagus nerves, the prognosis of treatment is very unfavorable.
Symptoms
On subtune and acute stages disease, the clinical picture is quite bright and is expressed by the following symptoms:
- Paresthesia of the calf muscles. The patient feels a burning sensation, tingling in the calves.
- Sore muscles on pressure.
- Deterioration of tendon reflexes.
- Decreased temperature, pain sensitivity.
- Syndrome "gloves and socks". The patient feels as if he has something on his legs and arms.
- Muscle weakness, atrophy.
- Swelling of the hands, feet, discoloration of the skin of the extremities.
- Dryness, marbling of the skin.
- Difficulties in bending the feet, lifting on toes.
- Feeling of lack of "ground underfoot".
- Cold hands and feet at normal outside temperature.
- Violation of gait, coordination of movement.
- The formation of ulcers, necrotic areas on the limbs.
- Pressure surges, urination disorders, tachycardia.
- Mental disorders.
Important: characteristic difference disease is that nerve damage occurs symmetrically.
Diagnostics
Diagnosis of alcoholic polyneuropathy is carried out using the following methods:
- Electromyography- hardware measurement of bioelectric muscle activity. It is used to assess the motor potential of muscles at rest and in motion.
- Electroneurography. Method for measuring the speed of a nerve impulse.
Nerves are examined in several ways:
- superficial. Electrodes are attached to the skin, then measurements are taken. The easiest and painless method.
- Needle. Needle electrodes are inserted into the muscles and determine its activity.
- Stimulant. Nerve fibers are stimulated with skin and needle electrodes.
To differentiate the disease from other types of neuropathy (diabetic, uremic), a biopsy of the nerve fiber or cerebrospinal fluid is prescribed.
Treatment
Pathology treatment requires integrated approach. The first step is the complete exclusion of any alcohol and the establishment of good nutrition.
Then a course of treatment is prescribed, which includes the following methods:
- Medical therapy.
- Physiotherapeutic effect.
- Therapeutic exercise.
- Psychotherapeutic classes.
Medication treatment
Restoration of the nervous system is carried out using the following groups of drugs:
- Eliminating the toxic effect of ethanol. This includes:
- solutions of glucose.
- Means of alpha-lipoic acid (Thiogamma, Octolipen). They bind free radicals, normalize cellular metabolism.
- Drugs that have a vasoactive effect, that is, improve cellular blood supply. This includes Pentoxifylline, Halidor. They restore the lost properties of neurons.
- B vitamins (Milgamma, Kombilipen).
- Replenishing oxygen deficiency (Actovegin, Piracetam, Curantil). Means improve oxygen utilization, restore oxygen metabolism of cells.
- Restoring nerve conduction (Neyromedin). It normalizes the process of transmission of nerve impulses, increases muscle tone.
- Non-steroidal anti-inflammatory drugs (Nise, Declofenac, Ibuprofen). They stop pain, eliminate inflammation.
- Anticholisterase agents (Remenil, Alzepil). They are used to treat movement disorders. Medicines increase the contraction of smooth muscles, increase the tone of the nerves.
- Cerebral ganglios. Activate nerve growth factors, restore the destroyed myelin sheath.
- Hepatoprotectives (Esliver Forte, Karsil, Essentiale). Restore damaged liver cells, remove toxins.
- Antidepressants (Amitriptyline, Paroxetine). Stabilize the mental state of the patient.
Physiotherapy
The following physiotherapy methods help to speed up the recovery of affected nerves:
- electrical stimulation. Nerves are stimulated with currents at a certain frequency, which improves nerve conduction.
- electrophoresis. The body is affected by constant electrical impulses. In this way, drugs are delivered to the site of the lesion.
- Magnetotherapy. Based on the impact of constant or variable magnetic field with low frequency.
- Acupuncture. Nerve recovery is carried out by inserting needles into acupuncture points.
Physiotherapy
Exercise therapy is aimed at recovery muscle tone improving limb mobility. The patient should perform a simple set of exercises daily, then he will feel an improvement:
Psychotherapy
Psychotherapy is essential for people suffering from alcohol addiction. The task of the doctor is to make the alcoholic aware of his problem and express a desire to overcome it. A person should feel that he is not alone, he will be helped and he will be cured. It is important to understand why the patient became an alcoholic, which was the impetus for the development of addiction.
Psychotherapeutic influence is carried out by the following methods:
- Individual conversations with a psychologist.
- Group lessons.
- Hypnosis sessions.
- Treatment through play.
Complications of the disease, prognosis
If alcoholic polyneuropathy is not treated, the disease will progress and the patient will develop serious complications:
- Renal and liver failure.
- Impaired cardiac function.
- Heart attack.
- Paralysis of the limbs.
- tissue necrosis.
- Alcoholic dementia.
- Mental disorders.
- Complete loss of sensation in the legs and arms.
- Visual impairment up to complete blindness.
The prognosis of the disease depends on timely treatment and the complete rejection of alcohol.
The majority of patients go to the doctor too late, when they lose the ability to move and perform their usual actions. If changes in the nervous system are irreversible, then the patient is assigned a 2nd disability group.
[Total Votes: 8 Average: 4/5]Prolonged and continuous alcohol abuse leads not only to the complete degradation of a person's personality, but also affects the occurrence of various diseases internal organs. Alcoholic polyneuropathy also belongs to such ailments, according to statistics, it occurs in 10% of patients suffering from alcohol dependence, regardless of whether it is a woman or a man.
Causes of the development of alcoholic polyneuropathy
The toxic effect of alcohol breakdown products adversely affects the peripheral nervous system, disrupts metabolic processes and the transmission of impulses, which becomes the basis for the symptoms of the disease. Pathological changes affect all departments in the spinal cord and brain.
Polyneuropathy from alcohol abuse develops in the last stages of the disease, the cause of its occurrence is:
- The toxic effect of ethyl alcohol and its decay products on nerve fibers;
- Deficiency of the B group of vitamins. The lack of this group of vitamins is due to monotonous nutrition, impaired functioning of liver cells and a decrease in the absorption of nutrients from the intestinal mucosa. A small amount of thiamine does not allow alcohol to be fully oxidized, which only enhances its toxic effect and reduces the rate of metabolic processes.
- Violation of microcirculation in the structure of the nerve fiber.
The risk of polyneuropathy increases several times with the use of surrogate alcohol, various methylated spirits and chemical alcohol-containing liquids.
Such liquids have the most toxic effect on the liver, due to which B vitamins are quickly destroyed and complete violation metabolism.
Course of the disease
Alcoholic polyneuropathy in most patients develops gradually, but due to the constant presence in alcoholic dope, a person does not pay attention to the appearance of the first clinical signs.
The acute onset of the disease causes the intake of large doses of alcohol for several days.
Patients begin to pay attention to their health when there is a pronounced weakness in the legs and the inability to move.
Very often, alcoholic polyneuropathy is a harbinger of a more serious disease such as
which is very difficult to treat.
Alcoholic polyneuropathy of the lower extremities is the most common manifestation of the disease in the initial stage.
Complaints of patients with alcoholic polyneuropathy
Attention to the fact that health problems appeared at the initial stage of polyneuropathy, the patient can only pay attention while being in a sober state. Typically, patients experience the following symptoms:
- Convulsive contractions of the muscles in the toes.
- Numbness and goosebumps in the limbs - paresthesia that appeared after a night's sleep. Sensitivity in the legs is restored in a few minutes or hours.
- Pain in the feet calf muscles. Soreness appears first at night, as the disease develops, it becomes permanent.
- A characteristic sign is soreness and discomfort with slight palpation of the calf muscles.
- Often painful cramps develop in the muscles of the leg.
- The lower extremities are periodically cold even on summer days.
- As the disease progresses, there is persistent weakness in the legs, and then in the arms.
- In rare cases, the patient complains about the eye movement disorders.
Clinical signs of the disease increase as more and more nerve fibers are involved in the pathological process. Symptoms of the disease can also undergo a reverse development, provided that alcohol-containing liquids are completely abandoned.
Manifestations of alcoholic polyneuropathy
In alcoholic polyneuropathy, motor disorders come to the fore. A cock's gait appears due to dysfunction of the extensor muscles in the foot.
Atrophy of the calf muscles develops rapidly, which is manifested by weight loss of the lower extremities. The muscles of the hand are included in this pathological process much later than the leg muscles.
Due to the violation of sensitivity, it seems to the patient that the surface of the floor has become soft.
The structure and color of the skin also changes - the limbs become marbled, the skin is dry, brittle nails increase, and excessive sweating, the hairline on the shins disappears, at the end of the disease trophic ulcers and edema appear.
- Paresis and paralysis at the initial stage last a short period of time, then they can significantly limit the patient's mobility.
- As further toxic damage to nerve fibers is affected nervus vagus resulting in shortness of breath and tachycardia.
- A feature of the course of polyneuropathy of alcoholic genesis is its combination with amnesic syndrome, which is manifested by a lack of memory for ongoing events, disorientation in space and time.
- On examination, the doctor pays attention to the violation of sensitivity in the calf muscles, on the arms and legs, this is recorded as the absence of reflexes in the area of putting on gloves and socks.
- Damage to the nerves begins with the lower sections and gradually spread to the entire body. This feature explains the appearance of the first symptoms of the disease in the lower extremities.
Alcoholic polyneuropathy must be distinguished from diabetic polyneuropathy. Diabetic polyneuropathy has similar clinical symptoms, is sometimes the first sign of diabetes. The diagnosis is made on the basis of blood tests and instrumental examinations.
Treatment of alcoholic polyneuropathy
Success in the treatment of alcoholic polyneuropathy in general and in the treatment of polyneuropathy of the lower extremities depends on how much and how quickly the patient can stop drinking alcohol.
Medical treatment consists of groups of drugs used in courses. First of all it is:
- Appointments of thiamine and other B vitamins in injections and tablet form. Vitamin complex is found in medicines, like Trigamma, Combilepen, Neurorubin - forte.
- Drugs that improve microcirculation and metabolic processes in the body. From modern medicines this group includes Thioctacid, Dialipon, Thiolepta.
- At pain syndrome anti-inflammatory drugs and analgesics diclofenac, ibuprofen, baralgin, smazgan are used.
Help to quickly restore the motor sphere in a state and facilities traditional medicine about which you can read more used in conjunction with medicines prescribed by a doctor.
- Vitamin cocktail is prepared from one fresh chicken egg, two spoons of honey and olive oil. This mixture is whipped and 100 grams of fresh carrot juice is added to it. The cocktail is taken twice a day.
- Kefir mixed with seeds and fresh parsley. Two tablespoons of seeds and parsley are crushed, poured with a glass of kefir and drunk 40 minutes before breakfast. The mixture perfectly removes toxins and saturates the body with vitamins.
- From external means, baths prepared from the infusion of coniferous branches and from the pods of red hot pepper are used. Keep your feet in this liquid for up to 30 minutes a day, then put on warm socks.
It will help to cope with alcohol addiction during the treatment of the disease with soothing herbs - motherwort, thyme, valerian.
Positive dynamics can be achieved only after several months of therapy with complete failure from alcohol. Of great importance is good nutrition And exercise aimed at strengthening the muscles.
Forecast
Without treatment, the symptoms of alcoholic polyneuropathy increase, for the patient this can result in paralysis of the limbs, mental disorders, damage to the cerebellum, in which functional disorders of coordination of movements are observed.
