Marchiafava-Bignami Disease Treatment & Management

Updated: Oct 12, 2016
  • Author: Jennifer L Ault, DO, DPT; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
  • Print
Treatment

Approach Considerations

No specific, proven treatment is available for Marchiafava-Bignami disease (MBD). Various treatments similar to those commonly administered for Wernicke-Korsakoff syndrome or for alcoholism in general have been given to patients with MBD. Some patients have improved and some have not. The most common treatments are thiamine, folate, and other B vitamins (especially vitamin B-12). Folate is commonly given with B-12.

Because thiamine deficiency is associated with malnutrition and prolonged vomiting in alcoholics, MBD patients with these symptoms may benefit from parenteral thiamine administered within 2 weeks of symptom onset. [28]

With regard to more unusual treatments, a case report by Staszewski et al described amantadine given together with thiamine, vitamin B-12, and folate; the patient improved. [17] In another case, reported by Kikkawa et al, administration of high-dose corticosteroids was said to precede clinical improvement. In patients who improved, the CT and MRI scan findings also improved, at least somewhat. [29]

Inpatient care

Patients are usually admitted because they present with stupor, coma, and, frequently, seizures.

Follow-up

Patients who survive should receive rehabilitation and, if appropriate, alcohol and nutritional counseling.

Consultations

Depending on the specific presentation and course of MBD, the patient may require consultation with the following specialists:

  • Neurologist - For seizure control

  • Critical care specialist - For coma management

  • Neuropsychologist - For workup of the dementia

  • Neurorehabilitation specialist

  • Psychiatrist or psychologist - For treatment of alcoholism