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.
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.
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.
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.
Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) leukocyte activity.
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.
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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T2-weighted axial image in a patient with Marchiafava-Bignami disease showing a high-signal lesion in the corpus callosum.
