Home Audience 5 Alcoholic polyneuropathy prognosis. Non-drug treatment of neuropathy. Causes of alcoholic polyneuropathy

Alcoholic polyneuropathy prognosis. Non-drug treatment of neuropathy. Causes of alcoholic polyneuropathy

Towards development alcoholic polyneuropathy lower extremities is caused by alcohol abuse. This neurological disease causes damage to the peripheral nervous system and develops due to toxic damage to the body. The disease has negative impact on the nervous system, causing serious illness.

Causes of neuropathy

Alcoholic polyneuropathy of the lower extremities occurs due to the consumption of alcoholic beverages in large quantities (both after a single and multiple doses). However, not all patients diagnosed with neurological pathology have a tendency to drink alcohol, so alcohol is not the only cause of the development of the disease.

Development alcoholic neuropathy also occurs under the influence of the following factors:

Polyneuropathy of the lower extremities when drinking alcohol develops in several stages:

Decrease in receipts nutrients to tissues due to toxic effects ethyl alcohol that disrupts metabolism.
Reduced speed of impulses passing through nerve fibers.
Damage to the central and peripheral nervous system.
Dysfunction of the digestive organs (deterioration of absorption of the intestinal walls).
Weakening of the immune system, which causes the body to produce antibodies that “attack” healthy cells.
Accumulation of toxins in the body due to metabolic disorders.

The development of alcoholic polyneuropathy of the lower extremities has not been fully studied. However, researchers have found that the main target of alcohol intoxication is axons. These processes are responsible for transmitting nerve impulses.

With prolonged consumption of alcohol-containing drinks, the liver suffers and the concentration of B vitamins in the body sharply decreases.

Symptoms

Alcoholic neuropathy of the lower extremities initially has symptoms in the form of weakness in the lower leg muscles. However, this symptom is used to characterize a number of other diseases and simply physical fatigue. Therefore, most people do not pay attention to the primary manifestations of pathology and begin treatment at late stages its development.

The following symptoms indicate polyneuropathy of the lower extremities:

Damage to the peripheral nervous system manifests itself in the form of a sensation of “pins and needles” in the lower extremities, partial or complete numbness. This symptom is complemented muscle cramps. And the intensity painful sensations in the lower body increases with contact or physical activity.

Atrophy develops over time muscle fibers, accompanied by the appearance of ulcers on the surface of the skin. In severe cases, symptoms of alcoholic neuropathy include rapid heartbeat, increased sweating, shortness of breath. These factors indicate lung damage, which requires immediate medical attention.

With acute intoxication of the body, confusion and signs of mental disorders. Violations of facial expressions and temporary retention of urination are also possible.

An important feature of alcoholic polyneuropathy is that about a month after the onset of the first signs, relief occurs, but this symptom indicates the transition of the disease to the chronic phase.

If your legs just start to hurt, you need to seek help from a doctor and undergo a course of treatment for alcohol addiction.

Diagnosis of polyneuropathy

Diagnosis of lower extremity neuropathy begins with collecting information about the patient. The symptoms described above can signal many other pathologies, which can often be excluded at the stage of communication with the patient.

At the next stage, an examination of the legs is carried out, which reveals the changes that have occurred: muscle weakness, numbness, atrophy and other signs of damage.

To differentiate polyneuropathy from other neurological disorders, electroneuromyography is used. ENMG allows us to identify the degree of damage to nerve fibers, the presence inflammatory process and the course of degenerative processes. If a disease is suspected, a biopsy is additionally prescribed to confirm the diagnosis.

Treatment of alcoholic neuropathy of the lower extremities

Alcoholic polyneuropathy is treated comprehensively. Based on the diagnostic results, a course of medication is prescribed, which is designed to eliminate the deficiency of microelements and relieve the patient from accompanying symptoms. Successful therapy requires lifestyle adjustments that include complete abstinence alcoholic drinks.

Physiotherapeutic procedures and exercise therapy help speed up the patient’s recovery. For mild forms of damage associated with alcoholic polyneuropathy of the lower extremities, treatment is possible folk remedies. During the rehabilitation period, it is important to change the daily diet in favor of proper nutrition.

Drug therapy

Treatment of alcoholic polyneuropathy of the lower extremities is carried out using the following drugs:

Regardless of the stage of development of the pathology, antidepressants (Amitriptyline, Paroxetine) and antiepileptic drugs (Carbamazepine, Neurontin) are recommended. Alcoholic neuropathy requires the prescription of non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen).

For such lesions, agents that have a stimulating effect on metabolic processes are recommended. These drugs include nootropics. Medicines in this group have a positive effect on the exchange of nucleins in the intercellular space of nerve fibers. Nootropics restore the functioning of the central nervous system, suppressing the symptoms of neuropathy.

IN drug therapy additionally include hepatoprotectors. These drugs restore liver function and prevent organ damage.

Physiotherapy

Treatment of alcoholic polyneuropathy of the lower extremities is intended to restore their lost functions. For these purposes, in addition to medications Physiotherapeutic measures are indicated:

massage;
electro- and magnetic therapy, stimulating the functioning of the nervous system;
blood purification using appropriate devices;

Physiotherapeutic procedures are usually prescribed after a course of drug therapy.

These measures are carried out over several months, since neuropathy provokes serious disorders that require long-term recovery.

During the rehabilitation period, the patient is prescribed a course of gymnastic exercises that normalize muscle tone.

Diet

Due to the fact that alcoholic polyneuritis of the lower extremities affects the entire body, a constant supply of nutrients is necessary for the patient’s rehabilitation. For this purpose, the patient is transferred to a specialized diet that includes the consumption of animal liver, fermented milk products, vegetables and fruits.

It is especially important to include in your diet dishes that contain B vitamins. In addition to liver, these microelements are found in bran and sprouted wheat.

Since alcohol has a detrimental effect on the functions digestive system, it is recommended to exclude spicy and salty foods from the diet, which place additional stress on the gastrointestinal tract.

Treatment with folk remedies

In addition to traditional therapy a person suffering from alcoholic neuropathy of the lower extremities will benefit from treatment with folk remedies: tinctures on the herbs of valerian, motherwort and thyme. These drugs are allowed to be taken subject to the approval of a doctor.

Effective comprehensive treatment and traditional therapy are factors in the successful fight against the disease.

If the lower extremities are affected, the following remedies are indicated:

Decoctions from string, oregano, marigold, bedstraw. These components are taken in equal proportions and mixed with licorice and burdock roots, elderberry flowers, hop cones, and birch leaves. Add 2 cups of boiling water to the mixture. The decoction is infused for three hours. The product helps restore metabolism.
A decoction of parsley and sunflower to remove toxins. You will need 2 tbsp. seeds and half a glass of greens. 300 ml of kefir are added to the mixture. The composition is taken 40 minutes before breakfast.
A mixture of milk thistle seeds and sunflower oil. You will need 4 tbsp. seeds and 150 ml of oil. The ingredients are mixed with each other and with 2 tbsp. dried peppermint. The resulting composition is consumed three times a day before meals. This remedy normalizes liver function.

Traditional medicine does not replace drug therapy, but complements it.

Forecast and consequences

Recovery from polyneuropathy of the lower extremities takes up to six months, provided that all medical prescriptions are followed. Refusal of therapy leads to the development severe complications. Alcoholic neuropathy causes partial or complete paralysis, cerebellar damage, central nervous system dysfunction and the appearance of mental disorders. The patient may also die due to liver damage or cardiac arrest.

Prevention

The only way to prevent alcoholic neuropathy of the lower extremities is to completely abstain from consuming alcohol-containing products. It is also recommended to follow the principles of proper nutrition and lead an active lifestyle to prevent metabolic disorders.

When a person has become an alcoholic for a long time, then, against the background of constant alcohol consumption, he begins to develop dangerous disease- alcoholic polyneuropathy. This happens because any alcohol is very toxic; it leads to disruption of metabolic processes and impulse transmission. Pathological changes can affect various parts of the brain and spinal cord.

Causes of alcoholic polyneuropathy

Polyneuropathy from constant alcohol consumption will develop only in the last stages of alcoholism. The causes of the disease are as follows:

If a person drinks surrogate alcohol rather than store-bought alcohol, then the risk of developing the disease increases several times. This occurs due to chemical alcohol-containing liquids and denatured alcohols.

These fluids have a serious impact on the liver, causing B vitamins to be destroyed almost instantly. Because of this, there is a metabolic disorder.

Symptoms of alcoholic polyneuropathy

Due to the fact that the development of alcoholic polyneuropathy is based on a combination of several causes, the disease is very variable in terms of clinical presentation.

Among the main symptoms of the disease are:

Symptoms of alcoholic polyneuropathy, regardless of their origin, are explained by simultaneous damage to a lesser or more peripheral nerves. The predominance of one or another clinical signs will depend on the damage to the specific 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. Vibratory and proprioceptive (deep) sensitivity is also carried out 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 simultaneously. Vegetative fibers are thin, unmyelinated.

When thin fibers are affected, there is usually a selective loss of temperature or pain sensitivity. Spontaneous pain and paresthesia also occur (even with a normal reflex). Thick fiber neuropathy will typically be accompanied by areflexia, muscle weakness, sensitive ataxia. Damage to vegetative fibers is usually the cause of somatic symptoms. If all fibers are involved, then mixed (vegetative and sensorimotor) polyneuropathy is observed.

The manifesting symptoms, in most cases, consist of two clinical patterns: symmetrical motor-sensory and symmetrical sensory polyneuropathy. In the first stages of the disease, a predominance of impaired proprioceptive sensitivity is observed. Alcoholics in this case complain of pressing pain in the calf muscle. In this case, the morphological substrate of the lesion is primary axonal degeneration, as well as secondary demyelination.

Neurophysical studies clearly show that usually two types of nerve fibers can be affected (thick and thin), but lesions can also be isolated (thin only or thick only). This may explain the diversity of the clinical picture of alcoholic polyneuropathy. Scientists have not yet discovered any relationship between the type of affected fibers and the clinical specifics of alcohol abuse.

It is believed 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. A study of nonalcoholic neuropathy with thiamine deficiency and alcoholic neuropathy without thiamine deficiency demonstrates major differences between the two conditions. Non-alcoholic neuropathy with thiamine deficiency is usually characterized by a rapid onset, rapid development, dominance in the clinical picture of motor disorders in combination with symptoms of damage to superficial and deep sensitivity.

On the other hand, alcoholism without thiamine deficiency progresses quite slowly. In this case, the dominant symptom is a violation of surface sensitivity in combination with severe pain. Biopsy of the sural nerve shows extensive damage to the axons of small fibers, especially in the early stages of the development of alcoholic polyneuropathy. The last stages of the disease can be characterized by fiber regeneration processes.

In non-alcoholic neuropathy with thiamine deficiency, 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-deficiency alcoholic polyneuropathy exhibits a typically variable combination of symptoms that are characteristic of thiamine-deficiency neuropathy. From all of the above, we can conclude that the clinical picture is formed largely on the basis of concomitant thiamine deficiency.

The diagnosis of the disease is valid if electrophysiological changes are detected. They must occur in two nerves and a muscle in combination with subjective symptoms (patient complaints) as well as objective manifestations of the disease (information about neurological status). At the same time, other etiologies of polyneuropathies must be excluded, and anamnestic data on alcohol abuse must be obtained from the patient or his relatives.

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 that is not typical for neuromuscular fibers.

Fiber biopsy is performed in difficult diagnostic cases. This type of study is used in cases where it is necessary 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, treatment in this case will be incorrect.

Prognosis of alcoholic polyneuropathy

Symptoms of the disease without proper treatment will increase. For the patient, this usually results in various mental disorders, paralysis of the limbs, damage to the cerebellum, in which functional disorders of coordination of movements can be observed.

Polyneuropathy, which will be detected in the first stages, is not so difficult to treat. Symptoms of the disease may develop in the opposite direction, but if the patient returns to drinking alcohol, then the disorders 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 drinking alcohol and also start leading an active lifestyle, which will help the body regain lost strength.

Features of the treatment of alcoholic polyneuropathy

If the correct medical care, then the prognosis for people who suffer from alcoholic neuropathy is very good. The main condition for positive rehabilitation is abstinence from alcoholic beverages, as well as a balanced and nutritious diet.

During treatment, efforts must be directed toward restoring lost body functions. Treatment should be carried out taking into account the body's vulnerability to neuropathy, which developed along with the disease. Any omissions cause subsequent damage.

The patient should not take strong painkillers. The frequency of taking pain medications should be limited to prevent the person from developing drug dependence.

Given the fact that the patient is deficient in multiple nutrients, he is attributed food additives and vitamins that help the body recover under particularly difficult conditions. Drugs of this type will eventually neutralize the signs of the disease, as a result of which their spread will stop.

Due to loss of skin sensitivity, patients will need to carefully monitor thermoregulation, protecting themselves from hypothermia.

Medicines 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, octolipene, berlition);
Drugs with a vasoactive effect (pentoxifylline, halidor);
Vitamins (mostly 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 effectiveness on high level found in nucleotides (cytidine, uridine), as well as in cerebral gangliosides, which improve the excitability of peripheral nerve fibers and facilitate reinnervation processes.

Typically, symptomatic treatment is aimed at eliminating pain with the help of combilipen, milgamma, compligam B containing thiamine. Anticonvulsants and antidepressants also prove their effectiveness in this case.

Patients who have peripheral paresis are recommended to exercise, massage, therapeutic exercises, which allows you to strengthen muscles and also prevent the development of contractures.

Psychological support for 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 completely abstaining from drinking alcohol and following the doctor’s instructions.

Patients who suffer from alcoholic polyneuropathy should understand that this disease must be treated, even if they have no neurological symptoms. Otherwise, encouraging forecasts may not be expected.

Alcoholism gradually, painfully destroys a person. Ethanol is very toxic substance, and its breakdown products cause irreparable damage to all body systems. Alcoholism leads to weakened immunity, deterioration mental health, complete personal degradation.

– one of dozens of diseases that arise from alcohol abuse.

– dangerous disease, manifested in intoxication of the nervous system. But not only alcoholism can cause polyneuropathy - diabetes mellitus or an infectious infection can provoke this disease.

In the first two cases, the disease develops in stages, with a gradual worsening of symptoms. In approximately 10% of cases, polyneuropathy develops extremely sharply and can cause serious damage to the body in just a few days. But don’t be upset in advance - medical intervention carried out on time will lead to early stages illness, will allow you to completely cope with it. Otherwise, it may become chronic.

Alcoholic polyneuropathy according to ICD-10 has code G62.1

Symptoms of alcoholic neuropathy

Symptoms appear slowly, so neuropathy is not easy to identify. The main symptom of the disease is damage to the patient’s nervous system.

At first, a person experiences slight numbness in the fingers and toes. After that discomfort spread further to the limbs. Blood circulation deteriorates, subsequently the patient may feel cold in the legs.

The muscles gradually atrophy, their visual decrease can be observed with your own eyes. Severe cramps become more frequent, especially at night. The skin on the lower extremities turns blue and takes on a “dead” color.

Further development of the disease leads to complete paralysis of all limbs. As a result, the person cannot move and becomes physically incapacitated. Often from this moment on, most patients spend all their time without getting out of bed.

The destructive effect of alcoholic polyneuropathy of the lower extremities does not end there - the body continues to weaken, the person may experience phantom pain, as often happens after amputation. Mental health disorders can also make the disease worse.

Neuropathy is also not limited to problems with the limbs - its influence extends to the visual, respiratory functions And cardiovascular system. But first of all, it is the patient’s legs that are at risk - everyday deterioration increasingly interferes with motor function.

Regardless of the causes of neuropathy, its main symptoms are similar: cramps, gradual muscle atrophy, and, as a result - paralysis, development of further side symptoms may differ in individual situations.

During medical intervention and treatment of the disease, symptoms gradually subside reverse order, although in some situations, some primary symptoms may remain after treatment.

Diagnosis of alcoholic polyneuropathy

First of all, in medical institution The doctor collects information about the patient, his habits, and lifestyle. A check is carried out for extraneous factors, diseases that could provoke polyneuropathy, after which the patient is examined by a neurologist to detect primary signs diseases.

Electroneuromyography(ENMG) is a procedure that allows you to determine the degree of damage to the nervous system. It reveals how far the disease has spread, whether peripheral nerves are affected and what stage of the disease is acute or chronic. ENMG can detect muscle dystrophy, carpal tunnel syndrome, amyotrophic syndrome. Regular electroneuromyography will help in monitoring treatment and monitoring the body’s recovery process.

In some cases, they carry out biopsy of nervous system tissue. This more complex procedure can reveal a number of other serious illnesses, and more accurately diagnose polyneuropathy. These methods will quickly identify the disease, its degree, spread and complications, which will help to begin treatment as quickly as possible.

In most cases, treatment of alcoholic polyneuropathy takes place at home. In the final stages of the disease, when the patient’s life is at risk, treatment is carried out in a hospital.

Depending on the cause of the disease, various etiological methods are used to determine the first steps in recovery. If this reason is alcoholism, then the main factor, without which everything further treatment will be useless - complete abstinence from alcohol. Namely, it is necessary to completely and forever give up alcohol, even in small quantities.

Unfortunately, it will be impossible for a person who abuses alcohol, especially for a long time, to get rid of this addiction on his own. The service here will include the help of a psychotherapist, coding methods and support from relatives and friends. The integrated use of these factors minimizes the likelihood of disruptions.

The next step towards returning to the human state is to resume correct mode And healthy image life. Thoughtful daily schedule healthy eating and physical activity will significantly speed up the patient’s recovery. For alcoholic neuropathy, it is necessary to focus on vitamin-rich and protein food. But you shouldn’t rely on your own knowledge for everything - make up detailed diet It is necessary individually for each person and only a doctor can do this.

Treatment with drugs

The above factors are combined with medication treatment.

In the treatment of alcoholic neuropathy, a number of drugs are used, which are divided into several main groups:

Vitamin complex. It is important for the patient to replenish the lack of vitamin B in the body. The drugs Pentovit and Complivit, which have a positive effect on the nervous system, will help with this.
Neurotropic drugs.
Nootropic drugs. They help development mental activity, reduce the effect of toxins on the brain and improve mental state patient (Piracetam, Phenibut, Glycine).
Antidepressants. This type of drugs also has a positive effect on the psyche and contributes to a person’s complete abstinence from alcohol (Amitriptyline).
Metabolic drugs. Improve metabolism. They are taken by patients during recovery in a comprehensive manner, together with physiotherapy.

In case of liver damage, hepatoprotective drugs and antioxidants may be prescribed for general strengthening body. Additionally, it is possible to use traditional medicine recipes. This is a tincture of cloves, milk thistle seeds, olive oil, and carrot juice.

Non-drug treatment of neuropathy

Physiotherapy and related procedures play an important role in the treatment of the patient. Electrical stimulation spinal cord and nerve fibers are quite often included in this category. Even procedures such as ordinary massage, physical therapy and acupuncture.

Magnetic therapy is widely practiced in our country, although there is no exact scientific confirmation of the effectiveness of this method. Only as a additional means treatment magnetotherapy is beneficial, although she has her fans and positive reviews. In US clinics, the use and sale of all products related to magnetotherapy is prohibited at the state level.

Emotional support– both therapeutic and at the household level important factor recovery. A calm everyday atmosphere, a change of environment and new acquaintances will speed up drug treatment and become a good prevention of alcoholic neuropathy.

Fulfillment of conditions for prevention: exclusion of alcohol from life, visiting health centers, regular rest and minimized stressful situations will make you forget about the disease.

There are numerous cases where patients in critical condition, on the verge of disability, fully recovered.

Complications of alcoholic neuropathy

The nervous system is the most complex structure of the human body. She is responsible for correct work organs, mental and motor abilities, genesis, and also affects other body systems. Accordingly, if the nervous system is disrupted and damaged, the entire body will suffer: organ failure and even complete cardiac arrest are possible. The disease can affect various nerves, for example, the optic nerve.

Muscle atrophy in the later stages can lead to permanent and irreversible disability. Problems with respiratory system will also make themselves felt. If the patient continues to drink alcohol in the later stages, then it is likely sharp deterioration memory, mental abilities, and in the end this will lead to dementia.

Alcoholic polyneuropathy is a neurological disease that causes dysfunction of multiple peripheral nerves. The disease occurs in alcohol abusers in the later stages of alcoholism. Due to the toxic effects of alcohol and its metabolites on the nerves and the subsequent disruption of metabolic processes in the nerve fibers, pathological changes. The disease is classified as axonopathy with secondary demyelination.

ICD-10	G62.1
ICD-9	357.5
DiseasesDB	9850
MedlinePlus	000714
eMedicine	article/315159
MeSH	D020269

General information

Clinical signs of the disease and their relationship with excessive consumption alcohol was described in 1787 by Lettsom, and in 1822 by Jackson.

Alcoholic polyneuropathy is detected in people who drink alcohol of any age and gender (with a slight predominance in women), and does not depend on race or nationality. On average, the prevalence rate is 1-2 cases per 100,000 thousand population (about 9% of all diseases that arise from alcohol abuse).

Forms

Depending on the clinical picture of the disease, the following are distinguished:

Depending on the course of the disease, there are:

chronic form, which is characterized by slow (more than a year) progression pathological processes(occurs often);
acute and subacute forms (develops within a month and is observed less frequently).

In patients chronic alcoholism There are also asymptomatic forms of the disease.

Reasons for development

The etiology of the disease is not fully understood. According to existing data, about 76% of all cases of the disease are provoked by the reactivity of the body in the presence of alcohol dependence for 5 or more years. Alcoholic polyneuropathy develops as a result of hypothermia and other provoking factors in women more often than in men.

Also, the development of the disease is influenced by autoimmune processes, and the triggering factor is certain viruses and bacteria.

Provokes liver disease and dysfunction.

All forms of the disease develop as a result of the direct influence of ethyl alcohol and its metabolites on peripheral nerves. The development of the motor and mixed forms is also influenced by a deficiency in the body of thiamine (vitamin B1).

Thiamine hypovitaminosis in alcohol-dependent patients occurs as a result of:

insufficient intake of vitamin B1 from food;
decreased absorption of thiamine in the small intestine;
inhibition of phosphorylation processes (a type of post-translational modification of a protein), as a result of which the conversion of thiamine into thiamine pyrophosphate, which is a coenzyme (catalyst) in the catabolism of sugars and amino acids, is disrupted.

At the same time, the utilization of alcohol requires a large amount of thiamine, so drinking alcohol increases thiamine deficiency.

Ethanol and its metabolites enhance glutamate neurotoxicity (glutamate is the main excitatory neurotransmitter of the central nervous system).

The toxic effects of alcohol are supported by studies demonstrating a direct relationship between the severity of alcoholic polyneuropathy and the amount of ethanol consumed.
The condition for the development of a severe form of the disease is increased vulnerability nerve tissue resulting from a hereditary predisposition.

Pathogenesis

Although the pathogenesis of the disease is not fully understood, it is known that the main target in the acute form of alcoholic polyneuropathy is axons (cylindrical processes transmitting impulses nerve cells). The lesion affects thick myelinated and thin weakly myelinated or unmyelinated nerve fibers.

The increased vulnerability of nervous tissue is the result of the high sensitivity of neurons to various metabolic disorders, and especially to thiamine deficiency. Hypovitaminosis of thiamine and insufficient formation of thiamine pyrophosphate causes a decrease in the activity of a number of enzymes (PDG, α-CHCH and transketolase) involved in the catabolism of carbohydrates, the biosynthesis of certain cell elements and the synthesis of nucleic acid precursors. Infectious diseases, bleeding and a number of other factors that increase the energy needs of the body aggravate the deficiency of B vitamins, ascorbic and nicotinic acid, reduce the level of magnesium and potassium in the blood, causing protein deficiency.

With chronic alcohol consumption, the release of beta-endorphins from hypothalamic neurons is reduced, and the beta-endorphin response to ethanol is reduced.

Chronic alcohol intoxication causes an increase in the concentration of protein kinase, which increases the excitability of primary afferent neurons and increases the sensitivity of peripheral endings.

Alcohol damage to the peripheral nervous system also causes excessive formation of free oxygen radicals, which disrupt the activity of the endothelium (the layer of tissue lining inner surface vessels of flat cells that perform endocrine functions), cause endoneural hypoxia (endoneural cells cover the myelin sheath of the spinal cord nerve fibers) and lead to cell damage.

The pathological process can also affect Schwann cells, which are located along the axons of nerve fibers and perform a supporting (support) and nutritional function. These supporting cells of nerve tissue create the myelin sheath of neurons, but in some cases they destroy it.

In the acute form of alcoholic polyneuropathy, under the influence of pathogens, antigen-specific T and B cells are activated, which cause the appearance of antiglycolipid or antiganglioside antibodies. Under the influence of these antibodies, local inflammatory reactions develop, the set of blood plasma proteins (complement) involved in the immune response is activated, and a membrane-lytic attack complex is deposited in the area of the node of Ranvier on the myelin sheath. The result of the deposition of this complex is a rapidly increasing infection of the myelin sheath by macrophages with increased sensitivity, and subsequent destruction of the sheath.

Symptoms

In most cases, alcoholic polyneuropathy is manifested by motor or sensory disturbances in the limbs, and in some cases - muscle pain various localizations. Pain may occur simultaneously with motor disturbances, sensations of numbness, tingling and “crawling” (paresthesia).

The first symptoms of the disease appear in paresthesia and muscle weakness. In half of the cases, the disorders initially affect the lower extremities, and after a few hours or days they spread to the upper extremities. Sometimes patients' arms and legs are affected at the same time.

Most patients experience:

diffuse decrease in muscle tone;
a sharp decrease, and then the absence of tendon reflexes.

There may be a violation of facial muscles, and if severe forms diseases - urinary retention. These symptoms persist for 3-5 days, and then they disappear.

Alcoholic polyneuropathy in the advanced stage of the disease is characterized by the presence of:

Paresis expressed to varying degrees. Paralysis is possible.
Muscle weakness in the limbs. It can be either symmetrical or unilateral.
Sharp inhibition of tendon reflexes, progressing to complete extinction.
Surface sensitivity disorders (increased or decreased). They are usually weakly expressed and belong to the polyneuritic type (“socks”, etc.).

For severe cases The disease is also characterized by:

Weakening of the respiratory muscles, requiring mechanical ventilation.
Severe damage to joint-muscular and deep vibration sensitivity. It is observed in 20-50% of patients.
Damage to the autonomic nervous system, which manifests itself sinus tachycardia or, arrhythmia and sharp drop HELL.
Presence of hyperhidrosis.

Pain in alcoholic polyneuropathy is more common in forms of the disease that are not associated with thiamine deficiency. It can be aching or burning in nature and localized in the foot area, but more often it is radicular in nature, in which pain is localized along the affected nerve.

In severe cases of the disease, damage to the II, III and X pairs of cranial nerves is observed.

The most severe cases are characterized by mental disorders.

Alcoholic polyneuropathy of the lower extremities is accompanied by:

changes in gait as a result of impaired sensitivity of the legs (“splashing” gait, legs rise high during motor form);
impairment of plantar flexion of the feet and toes, inward rotation of the foot, drooping and turning of the foot inward in the motor form of the disease;
weakness or absence of tendon reflexes in the legs;
paresis and paralysis in severe cases;
blue or marbling of the skin of the legs, reduction of hair on the legs;
coldness of the lower extremities with normal blood flow;
hyperpigmentation of the skin and the appearance of trophic ulcers;
pain that intensifies when pressing on the nerve trunks.

Painful phenomena can increase over weeks or even months, after which a stationary stage begins. At adequate treatment the stage of reverse development of the disease begins.

Diagnostics

Alcoholic polyneuropathy is diagnosed based on:

Clinical picture of the disease. Diagnostic criteria are progressive muscle weakness in more than one limb, relative symmetry of the lesions, the presence of tendon areflexia, sensory disorders, rapid increase in symptoms and cessation of their development in the 4th week of the disease.
Electroneuromyography data, which can detect signs of axonal degeneration and destruction of the myelin sheath.
Laboratory methods. Includes cerebrospinal fluid analysis and nerve fiber biopsy to rule out uremic polyneuropathy.

In doubtful cases, MRI and CT are performed to exclude other diseases.

Treatment

Treatment of alcoholic polyneuropathy of the lower extremities includes:

Complete abstinence from alcohol and proper nutrition.
Physiotherapeutic procedures involving electrical stimulation of nerve fibers and the spinal cord. Magnetic therapy and acupuncture are also used.
Physical therapy and massage to restore muscle tone.
Drug treatment.

At drug treatment are appointed:

B vitamins (intravenously or intramuscularly), vitamin C;
pentoxifylline or cytoflavin, which improves microcirculation;
antihypoxants that improve oxygen utilization and increase resistance to oxygen deficiency (Actovegin);
neuromedin, which improves neuromuscular conduction;
to reduce pain - anti-inflammatory non-steroidal drugs(diclofenac), antidepressants, antiepileptic drugs;
to eliminate persistent sensory and motor disorders - anticholinesterase drugs;
cerebral gangliosides and nucleotide preparations that improve the excitability of nerve fibers.

In the presence of toxic liver damage, hepatoprotectors are used.

Symptomatic therapy is used to correct autonomic disorders.

This is a neurological disease in which there is damage to the peripheral nerves. According to research, this disease is observed in 85% of people suffering from alcohol addiction. Both men and women can suffer from the disease.

Reasons

Experts identify quite a few reasons why alcoholic polyneuropathy can develop. The most common cause is the constant toxic effects of ethanol products on the body, in particular on the nerve endings.

This effect inhibits metabolic processes, resulting in disruption of the flow of blood and nutrients to nerve impulses.

The central nervous system also suffers from the negative effects of acetaldehyde, a breakdown product of ethyl alcohol. Experts say that greatest danger Low-quality alcohol is harmful to health, since it may contain prohibited chemical compounds that lead to irreversible processes in the body.

In the case of long-term alcohol consumption, a person experiences severe liver dysfunction, which is a link with polyneuropathy. The immune system is also greatly affected by ethanol, in the body with high speed Antibodies develop that inhibit their own nerve tissue.

Often, alcoholic polyneuropathy develops due to a deficiency of vitamin B in the body, the absence of which occurs when there is a small amount of nutrients supplied and their poor absorption into the intestines.

If there is a deficiency of thiamine, then alcohol cannot completely leave the body, which causes it to last for a long time. negative influence to all organs.

If a person is in a strong drunkenness, while lying in the same position for a long time, compression of some internal organs, the nerve is damaged. Other reasons why the disease develops are excessive hypothermia, the ingestion of harmful substances and viruses into the body.

Forms

The disease progresses in different ways; it also occurs due to various reasons, from here experts have identified several forms of alcoholic polyneuropathy.

Sensory- characterized by significant pain in the extremities, a person feels constant chills in the feet, numbness, sometimes burning, cramps in the calves often occur, and it can even be painful to touch the feet in some places. There is also a loss of sensation in the palms and soles; the patient may feel dull pain. The sensory form occurs as a result of a violation of the autonomic-vascular system; excessive marbling and acrocyanosis can be observed on the skin, and weakness is noted in the tendons.

Motor. With this form, a person experiences a disorder of the peripheral nerves. The lower extremities, in particular the peroneal and tibial nerves, are also affected. If the tibial nerve is damaged, a person cannot bend the foot normally, move the toes, cannot bend the foot inward, or walk on the toes. Damage to the peroneal nerve results in the inability to straighten the feet and toes. The muscles in this area atrophy, and hypotonia of the feet occurs.

Mixed. If a person has mixed alcoholic polyneuropathy, then disorders of the motor and sensory apparatus occur simultaneously. The patient experiences pronounced numbness of the extremities, complete paralysis of the feet and hands, severe or mild pain, and a decrease or increase in sensitivity is observed. nerve endings, the extensor function suffers to a greater extent.

Atactic. The patient experiences a pronounced disturbance in gait, coordination suffers greatly, the legs and arms go numb, they feel practically nothing, and when pressing on the sole of the foot or on the palm, a stabbing pain is felt.

The disease is also divided into chronic and acute according to its course:

The chronic form is characterized by the fact that the disease develops slowly, and pathology gradually develops in the extremities. This form is the most common; usually a person begins to suffer after a year of alcohol dependence.
Acute form develops quickly, but is quite rare. For complete atrophy of the limbs, a person only needs to remain intoxicated for a month and a half.

Stages:

The first stage is characterized by the absence of symptoms of the disease, the clinical picture of the disease is also not visible, polyneuropathy can only be detected if you pass the necessary tests and undergo some examinations.
The second stage is easily detected by examination by a doctor, as well as based on complaints from the patient. There are no visible limb defects yet.
The third stage is expressed by a visual change in the limbs, pain, numbness, the person cannot walk normally.

Alcoholic neuropathy: symptoms and early diagnosis

The first thing a person feels is weakness in the muscles, usually manifesting itself in the morning after sleep, first the lower limbs go numb, and after a few minutes the arms begin to go numb. In some cases, numbness affects all limbs at once. The patient's tendon reflex, the Achilles reflex is most susceptible, muscle tone worsens.

Alcoholic neuropathy in neglected form manifested by symptoms such as: muscle weakness, paresis of the lower extremities, paralysis of the hands or feet, a person may not feel objects.

Sometimes the patient may complain of worsening visual reflexes. All of the listed signs of the disease are not permanent, they can last for several days, then disappear completely for one or two days, then recur. On last stage urination worsens, the person suffers nervous disorders, breathing becomes impaired, tachycardia, bradycardia, arrhythmia appear, and blood pressure drops sharply. A person can feel pain even in such forms of the disease when there is enough vitamin B and it settles in the foot. Character pain aching, burning sensations appear.

Along with this, a person’s gait is disturbed due to the fact that the feet become too sensitive, the foot cannot be bent inward, marbling, cyanosis, tingling, numbness in the calves, and cramps are visible on the legs.

Alcoholic neuropathy is not the only disease in which severe numbness of the limbs occurs; there are clones of this disease, namely diabetic polyneuropathy:

Diabetic polyneuropathy- characterized by blockage blood vessels in the limbs. A person with this disease, depending on the stage, feels periodic numbness in the hands or feet, the muscles become weak, the long ischial, femoral, ulnar nerves. People with diabetes mellitus they feel the same pain in their legs as alcoholics; they experience redness of the skin, cyanosis of the feet, the skin becomes dry, ulcers and rotting wounds form. Such patients should not drink alcohol under any circumstances. This disease is scary because, unlike alcoholic polyneuropathy, diabetic polyneuropathy cannot be cured; it progresses slowly.
Neuropathy of the lower extremities— the disease is characterized by a constant attack of numbness in the extremities, especially after a long walk, at which time the legs begin to break out, twist, and you want to constantly touch and massage them. This occurs as a result of compression of the peripheral nerves.
Upper limb neuropathy- the disease is similar to neuropathy of the lower extremities, the only difference is that with the first disease several nerves can be affected simultaneously, which can lead to temporary loss of sensitivity in the hands.

Early diagnosis

In order to identify the disease early stages the patient must have symptoms such as tendon laxity, muscle weakness; only on the basis of the clinical picture of the first signs can an analysis of the disease be carried out. This usually occurs when the patient is examined by a doctor at the first appointment.

Electroneuromyography allows you to identify the first signs of the disease, determines how severely the disease has developed, and whether the patient has nerve inflammation. For another examination, the doctor may order a nerve fiber biopsy. Such an examination must be done to exclude other types of polyneuropathy.

Alcoholic neuropathy and treatment principles

The disease can appear only after prolonged drinking. Depending on how severe the symptoms of the disease are and with what complications all this occurs, appropriate treatment is prescribed.

Alcoholic neuropathy is most effectively treated at an early stage. Specialists at appointment various drugs First of all, they try to restore the lost function of nerve endings and improve blood circulation in this area. In this case, the doctor needs to be especially careful in prescribing medications to avoid allergies.

The following drugs are prescribed:

Among non-drug methods, physiotherapy is distinguished, in this case electrical stimulation of nerve endings occurs. The doctor also prescribes massage to quickly restore muscle activity. You should engage in health activities exercise, take acupuncture courses.

Traditional treatment

Folk remedies are good for complex treatment diseases. Exists large number recipes for such an illness, we will consider the most effective of them. You can make a cocktail based on fresh carrot juice(100 g) add one yolk, a few drops of olive oil, two teaspoons of honey.

The ingredients are mixed in a blender and then consumed twice a day before meals. An infusion of bay leaves and fenugreek seeds (3 tablespoons) helps well. The mixture is brewed in a thermos for four hours.

Drink the infusion twice a day. This medicine helps speed up blood circulation in the vessels and normalizes sugar levels. Limbs can be lubricated topically olive oil with the addition of dry herb St. John's wort. The herb is poured with hot oil, left for 15 hours, and filtered. The product can be used to make compresses on the feet.

Forecast

Alcoholic neuropathy is highly treatable in the early stages. IN advanced cases You can become disabled, which is why it is so important to visit a specialist at the first symptoms of the disease. The effect of treatment is observed in those patients who sought help in time. You need to be patient, since the treatment will be long and persistent, you will need to eat right, and most importantly, not drink a drop of alcohol.

Alcoholic polyneuropathy can cause a number of complications, namely:

It should be remembered that at the first symptoms of this terrible disease, you need to see a doctor, otherwise you may lose your limbs for the rest of your life.