Marchiafava-Bignami Disease Medication

  • Author: Jennifer Ault, DO, DPT; Chief Editor: B Mark Keegan, MD, FRCPC   more...
 
Updated: Feb 3, 2012
 

Medication Summary

Thiamine is administered for Wernicke-Korsakoff syndrome, but no significant evidence suggests that thiamine is a specific treatment for Marchifava-Bignami disease (MBD). Vitamin B-12, folate, and other B vitamins (and sometimes multivitamins) are also frequently given to sick, alcoholic patients admitted to the hospital; the authors deem administering the same protocol of vitamin therapy that would be given to patients with possible Wernicke-Korsakoff syndrome justified.

The fact that the brain pathology can now be observed repeatedly via serial MRI scans raises the question of whether to try other treatments mentioned in the literature and then monitor the appearance of the brain. A course of high-dose IV corticosteroids (eg, 250mg methylprednisolone q6h) could be tried if the attending physician believes that the possible benefits outweigh the risks.

Likewise, a standard dose of amantadine (100mg bid) could be considered if the patient can safely take it orally or through a tube. However, remember that no method exists to calculate a risk-to-reward ratio from isolated case reports, and the improvement seen in the small number of individual patients who received such treatments might have occurred anyway with the passage of time.

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Vitamins, Water-Soluble

Class Summary

Improvement has been seen in the small number of individual patients who received treatments that included at least 1 agent in this drug category.

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Thiamine

 

Thiamine is a water-soluble vitamin that combines with adenosine triphosphate to form the coenzyme thiamine pyrophosphate, which is necessary for carbohydrate metabolism. The B vitamins are readily absorbed from the gastrointestinal (GI) tract (except in cases of malabsorption syndromes). Alcohol inhibits the absorption of thiamine, which occurs primarily in the duodenum.

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Immunosuppressants

Class Summary

Improvement has been seen in the small number of individual patients who received treatments that included at least 1 agent in this drug category.

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Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)

 

Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity.

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Antiparkinson Agents

Class Summary

Improvement has been seen in the small number of individual patients who received treatments that included at least 1 agent in this drug category.

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Amantadine

 

Amantadine inhibits N-methyl-D-aspartic acid (NMDA) receptor-mediated stimulation of acetylcholine release in rat striatum. Amantadine may enhance dopamine release, inhibit dopamine reuptake, stimulate postsynaptic dopamine receptors, or enhance dopamine receptor sensitivity.

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Contributor Information and Disclosures
Author

Jennifer Ault, DO, DPT  Resident Physician, Department of Neurology, Dartmouth-Hitchcock Medical Center

Jennifer Ault, DO, DPT is a member of the following medical societies: American Academy of Neurology, American Academy of Osteopathy, American Medical Association, and American Physical Therapy Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Eric Dinnerstein, MD  Consulting Staff Neurologist, Maine Medical Partners Neurology

Eric Dinnerstein, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Janssen Pharmaceuticals Grant/research funds PI conpensation

Mardjohan Hardjasudarma, MD, MS  Chief of Neuroradiology, Program Director, Professor, Departments of Clinical Radiology and Ophthalmology, Louisiana State University School of Medicine in Shreveport

Mardjohan Hardjasudarma, MD, MS is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Neuroradiology, Canadian Medical Association, Ontario Medical Association, Pennsylvania Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

B Mark Keegan, MD, FRCPC  Assistant Professor of Neurology, College of Medicine, Mayo Clinic; Master's Faculty, Mayo Graduate School; Consultant, Department of Neurology, Mayo Clinic, Rochester

B Mark Keegan, MD, FRCPC is a member of the following medical societies: American Academy of Neurology, American Medical Association, and Minnesota Medical Association

Disclosure: Novartis Consulting fee Consulting; Bionest Consulting fee Consulting

Additional Contributors

Jonathan S Rutchik, MD, MPH Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco

Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

References

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T2-weighted axial image in a patient with Marchiafava-Bignami disease showing a high-signal lesion in the corpus callosum.
 
 
 
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