eMedicine Specialties > Physical Medicine and Rehabilitation > Peripheral Neuropathy

Alcoholic Neuropathy: Follow-up

Author: Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Coauthor(s): William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center
Contributor Information and Disclosures

Updated: Sep 5, 2008

Follow-up

Further Outpatient Care

  • Encourage periodic follow-up visits to monitor for neuropathic progression, as well as to assess functional deficits and the effectiveness of prior interventions (eg, alcohol cessation, gait/balance training).

Deterrence

  • Cessation of alcohol consumption is necessary to improve or reverse the symptoms associated with alcoholic neuropathy. Attendance of support groups (eg, AA) or the use of pharmacologic intervention (disulfiram [Antabuse]) may be of benefit to the patient with alcoholic neuropathy. Unfortunately, disulfiram also can cause neuropathy.

Complications

  • Complications of alcoholic neuropathy include morbidity associated with falls and gait ataxia, as well as the potential for thermal injuries, burns, and pressure ulcers. Multiple organ systems, including the heart and eyes, can be adversely affected by nerve damage associated with excessive alcohol consumption. Alcoholic cerebellar damage coupled with neuropathic impairment of proprioception in the legs can be devastating to a patient's gait pattern and can make independent ambulation impossible.

Prognosis

  • According to Dell and Guzewicz, the prognosis for the arresting or reversal of symptoms associated with alcoholic neuropathy is fair to good following cessation of drinking.16

Patient Education

  • Educate patients on how to protect themselves from the deleterious effects of alcoholic neuropathy on touch, gait, balance, and general strength.
  • These patients should also be counseled on the need for rigorous skin checks of the lower extremities as a means of preventing ongoing morbidity.

Miscellaneous

Medicolegal Pitfalls

  • The patient must be asked whether he/she has a history of alcoholic beverage consumption; this question should not be omitted while taking the history of a patient with possible alcoholic peripheral neuropathy or any other disease. Patients may be reluctant to voluntarily admit to a history of problem drinking on an intake history form. This question should be asked directly of the patient and may help in making an accurate diagnosis of the individual's condition. It may even save the patient's life.
 


More on Alcoholic Neuropathy

Overview: Alcoholic Neuropathy
Differential Diagnoses & Workup: Alcoholic Neuropathy
Treatment & Medication: Alcoholic Neuropathy
Follow-up: Alcoholic Neuropathy
References
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References

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  2. Corsetti G, Rezzani R, Rodella L, et al. Ultrastructural study of the alterations in spinal ganglion cells of rats chronically fed on ethanol. Ultrastruct Pathol. Jul-Aug 1998;22(4):309-19. [Medline].

  3. Narita M, Miyoshi K, Narita M, et al. Involvement of microglia in the ethanol-induced neuropathic pain-like state in the rat. Neurosci Lett. Feb 27 2007;414(1):21-5. [Medline].

  4. Chen X, Levine JD. Mechanically-evoked C-fiber activity in painful alcohol and AIDS therapy neuropathy in the rat. Mol Pain. 2007;3:5. [Medline]. [Full Text].

  5. Miyoshi K, Narita M, Takatsu M, et al. mGlu5 receptor and protein kinase C implicated in the development and induction of neuropathic pain following chronic ethanol consumption. Eur J Pharmacol. May 21 2007;562(3):208-11. [Medline].

  6. Koike H, Iijima M, Sugiura M, et al. Alcoholic neuropathy is clinicopathologically distinct from thiamine-deficiency neuropathy. Ann Neurol. Jul 2003;54(1):19-29. [Medline].

  7. Koike H, Mori K, Misu K, et al. Painful alcoholic polyneuropathy with predominant small-fiber loss and normal thiamine status. Neurology. Jun 26 2001;56(12):1727-32. [Medline].

  8. Masaki T, Mochizuki H, Matsushita S, et al. Association of aldehyde dehydrogenase-2 polymorphism with alcoholic polyneuropathy in humans. Neurosci Lett. Jun 17 2004;363(3):288-90. [Medline].

  9. Avaria Mde L, Mills JL, Kleinsteuber K, et al. Peripheral nerve conduction abnormalities in children exposed to alcohol in utero. J Pediatr. Mar 2004;144(3):338-43. [Medline].

  10. Pessione F, Gerchstein JL, Rueff B. Parental history of alcoholism: a risk factor for alcohol-related peripheral neuropathies. Alcohol Alcohol. Nov 1995;30(6):749-54. [Medline].

  11. Ammendola A, Gemini D, Iannaccone S, et al. Gender and peripheral neuropathy in chronic alcoholism: a clinical-electroneurographic study. Alcohol Alcohol. Jul-Aug 2000;35(4):368-71. [Medline]. [Full Text].

  12. Peters TJ, Kotowicz J, Nyka W, et al. Treatment of alcoholic polyneuropathy with vitamin B complex: a randomised controlled trial. Alcohol Alcohol. Nov-Dec 2006;41(6):636-42. [Medline]. [Full Text].

  13. Fama R, Eisen JC, Rosenbloom MJ, et al. Upper and lower limb motor impairments in alcoholism, HIV infection, and their comorbidity. Alcohol Clin Exp Res. Jun 2007;31(6):1038-44. [Medline].

  14. Schott K, Schäfer G, Günthner A, et al. T-wave response: a sensitive test for latent alcoholic polyneuropathy. Addict Biol. Jul 2002;7(3):315-9. [Medline].

  15. Gane E, Bergman R, Hutchinson D. Resolution of alcoholic neuropathy following liver transplantation. Liver Transpl. Dec 2004;10(12):1545-8. [Medline]. [Full Text].

  16. Dell PC, Guzewicz RM. Atypical peripheral neuropathies. Hand Clin. May 1992;8(2):275-83. [Medline].

  17. Agelink MW, Malessa R, Weisser U, et al. Alcoholism, peripheral neuropathy (PNP) and cardiovascular autonomic neuropathy (CAN). J Neurol Sci. Dec 11 1998;161(2):135-42. [Medline].

  18. Bushbacher L. Rehabilitation of patients with peripheral neuropathies. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: Saunders; 1995:984.

  19. Hilz MJ, Zimmermann P, Rösl G, et al. Vibrameter testing facilitates the diagnosis of uremic and alcoholic polyneuropathy. Acta Neurol Scand. Dec 1995;92(6):486-90. [Medline].

  20. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. Oct 2006;19(5):481-6. [Medline].

  21. Monforte R, Estruch R, Valls-Sole J, et al. Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol. Jan 1995;52(1):45-51. [Medline].

  22. Nishiyama K, Sakuta M. Mexiletine for painful alcoholic neuropathy. Internal Medicine. 1995, June;34(6):577-9. [Medline]. [Full Text].

  23. Oishi M, Mochizuki Y, Suzuki Y, et al. Current perception threshold and sympathetic skin response in diabetic and alcoholic polyneuropathies. Intern Med. Oct 2002;41(10):819-22. [Medline]. [Full Text].

  24. Scholz E, Diener HC, Dichgans J, et al. Incidence of peripheral neuropathy and cerebellar ataxia in chronic alcoholics. J Neurol. Aug 1986;233(4):212-7. [Medline].

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Further Reading

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Keywords

alcoholic neuropathy, alcohol neuropathy, peripheral neuropathy, alcoholism-induced neuropathy, alcohol-related neuropathy, primary axonal sensorimotor peripheral polyneuropathy, neuropathy treatment, axonal neuropathy, neuropathy pain, symptoms of neuropathy, nutritional axonal sensorimotor polyneuropathy, nutritional neuropathy, toxic axonal sensorimotor polyneuropathy, alcoholism, alcohol addiction

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Contributor Information and Disclosures

Author

Scott R Laker, MD, Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center
Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

William J Sullivan, MD, Assistant Professor, Pain Medicine Fellowship Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center
William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Daniel D Scott, MD, MA, BS, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA, BS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Robert H Meier III, MD, Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke's Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital
Robert H Meier III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

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