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. In fact, 1 in 15,000 patients taking disulfiram develops peripheral neuropathy every year due to disulfiram toxicity. These patients are often misdiagnosed as having alcoholic neuropathy. [30]
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. [31]
A study by Di Ciaula et al found that sympathetic autonomic dysfunction occurring in chronic alcoholics improved after 12 months of abstinence, although, looking also at the gastrointestinal effects of alcoholism, the investigators determined that certain preabstinence problems, including dyspepsia and changes in gastric emptying and orocecal transit times, remained. [32]
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.
