Neurology, Neuropsychiatry, Psychosomatics

Advanced search

«Masks» of alcoholic polyneuropathy

Full Text:


The paper considers the aspects of clinical manifestations, diagnosis, and therapeutic approaches in alcoholic polyneuropathy (PNP). It gives the data available in the literature on the prevalence of this disease in different countries and on the frequency of alcohol drinking in men and women. The author describes main risk factors for alcoholic PNP, such as malnutrition, thiamine deficiency, direct alcohol toxicity, and a familial history of alcoholism. She characterizes the most important pathogenetic mechanisms in the development of PNP. Particular attention is paid to the clinical presentations and diagnosis of main types of PNP, such as toxic alcoholic (due to directly toxic effects of alcohol metabolites) and alcohol-related thiamine-deficient ones. The paper presents the management tactics in patients with various types of alcoholic PNP, which include combination treatment and ensure the impact (alcohol refusal; balanced nutrition with the addition of various medications) on the etiological factor of the disease. Taking into account the available evidence base, it is necessary to prescribe B-group vitamins to these patients. Alpha-lipoic acid preparations that have an effect on the peripheral and central nervous systems occupy a separate place in the treatment.

About the Author

N. V. Pizova
Yaroslavl State Medical University, Ministry of Health of Russia
Russian Federation
5, Revolutsionnaya St., Yaroslavl 150000, Russia


1. Callaghan BC, Price RS, Feldman EL. Distal Symmetric Polyneuropathy: A Review. JAMA. 2015 Nov 24;314(20):2172-81. doi: 10.1001/jama.2015.13611.

2. Teunissen LL, Eurelings M, Notermans NC, et al. Quality of life in patients with axonal polyneuropathy. J Neurol. 2000 Mar;247(3): 195-9. doi: 10.1007/s004150050562.

3. Grantz M, Huan MC. Unusual peripheral neuropathies. Part I: extrinsic causes. Semin Neurol. 2010;30(4):387-395. doi: 10.1055/s-0030-1267282.

4. Grantz M. Unusual peripheral neuropathies. Part II: intrinsic reactive causes. Semin Neurol. 2010;30(4):396-404. doi: 10.1055/s-0030-1267283.

5. Grantz M. Unusual peripheral neuropathies. Part III: intrinsic inherited causes. Semin Neurol. 2010;30(4):405-415. doi: 10.1055/s-0030-1267284.

6. Rothman KJ, Greenland S. Causation and causal inference in epidemiology. Am J Public Health. 2005;95(Suppl 1):S144-S150. doi: 10.2105/AJPH.2004.059204.

7. Julian T, Glascow N, Syeed R, Zis P. Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. J Neurol. 2019 Dec;266(12):2907-2919. doi: 10.1007/s00415-018-9123-1.

8. Azimova YuE, Ishchenko KA, Rachin AP. Diagnostics and treatment of neurological complications of alcoholism: «New wine in old glasses». Poliklinika. 2016;1(1):50–6. (In Russ.).

9. Lin KP, Kwan SY, Chen SY, et al. Generalized neuropathy in Taiwan: an etiologic survey. Neuroepidemiology. 1993;12(5):257-61. doi: 10.1159/000110326.

10. Koike H, Iijima M, Sugiura M, et al. Alcoholic neuropathy is clinicopathologically distinct from thiamine-deficiency neuropathy. Ann Neurol. 2003;54(1):19-29. doi: 10.1002/ana.10550.

11. Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. 2006 Oct;19(5):481-6. doi: 10.1097/01.wco.0000245371.89941.eb.

12. Zambelis T, Karandreas N, Tzavellas E, et al. Large and small fiber neuropathy in chronic alcohol-dependent subjects. J Peripher Nerv Syst. 2005 Dec;10(4):375-81. doi: 10.1111/j.1085-9489.2005.00050.x.

13. Palliyath S, Schwartz BD. Peripheral nerve functions improve in chronic alcoholic patients on abstinence. J Stud Alcohol. 1993 Nov;54(6): 684-6. doi: 10.15288/jsa.1993.54.684.

14. 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. 1995 Jan; 52(1):45-51. doi: 10.1001/archneur.1995.00540250049012.

15. Wetterling T. Drinking pattern and alcoholrelated medical disorders. Alcohol Alcohol. 1999 May-Jun;34(3):330-6. doi: 10.1093/alcalc/34.3.330.

16. Vittadini G. Alcoholic polyneuropathy: a clinical and epidemiological study. Alcohol Alcohol. 2001 Sep-Oct;36(5):393-400. doi: 10.1093/alcalc/36.5.393.

17. Ammendola A, Gemini D, Iannaccone S, et al. Gender and peripheral neuropathy in chronic alcoholism: a clinical-electroneurographic study. Alcohol Alcohol. 2000 Jul-Aug; 35(4):368-71. doi: 10.1093/alcalc/35.4.368.

18. Agelink MW1, Malessa R, Weisser U, et al. Alcoholism, peripheral neuropathy (PNP) and cardiovascular autonomic neuropathy (CAN). J Neurol Sci. 1998 Dec 11;161(2):135-42. doi: 10.1016/s0022-510x(98)00266-4.

19. Ammendola A, Tata MR, Aurilio C, et al. Peripheral neuropathy in chronic alcoholism: a retrospective cross-sectional study in 76 subjects. Alcohol Alcohol. 2001 May-Jun;36(3):271-5. doi: 10.1093/alcalc/36.3.271.

20. Ng K, Lin CS, Murray NM, et al. Conduction and excitability properties of peripheral nerves in end-stage liver disease. Muscle Nerve. 2007 Jun;35(6):730-8. doi: 10.1002/mus.20765.

21. Estruch R, Nicolas JM, Villegas E, et al. Relationship between ethanol-related diseases and nutritional status in chronically alcoholic men. Alcohol Alcohol. 1993 Sep;28(5):543-50.

22. Gonzalez-Reimers E, Alonso-Socas M, Santolaria-Fernandez F, et al. Autonomic and peripheral neuropathy in chronic alcoholic liver disease. Drug Alcohol Depend. 1991 May;27(3): 219-22. doi: 10.1016/0376-8716(91)90004-i.

23. Claus D, Eggers R, Engelhardt A, et al. Ethanol and polyneuropathy. Acta Neurol Scand. 1985 Sep;72(3):312-6. doi: 10.1111/j.1600-0404.1985.tb00876.x.

24. Michalak S, Michalowska-Wender G, Adamcewicz G, Wender MB. Erythrocyte transketolase activity in patients with diabetic and alcoholic neuropathies. Folia Neuropathol. 2013;51(3):222-6. doi: 10.5114/fn.2013.37706.

25. Gimsing P, Melgaard B, Andersen K, et al. Vitamin B-12 and Folate Function in Chronic Alcoholic Men with Peripheral Neuropathy and Encephalopathy. J Nutr. 1989 Mar;119(3): 416-24. doi: 10.1093/jn/119.3.416.

26. Hammoud N, Jimenez-Shahed J. Chronic Neurologic Effects of Alcohol. Clin Liver Dis. 2019 Feb;23(1):141-155. doi: 10.1016/j.cld.2018.09.010.

27. Chopra K, Tiwari V. Alcoholic neuropathy: Possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012 Mar;73(3): 348-62. doi: 10.1111/j.1365-2125.2011.04111.x.

28. Dervaux A, Laqueille X. Thiamine (vitamin B1) treatment in patients with alcohol dependence. Presse Med. 2017 Mar;46(2 Pt 1):165-171. doi: 10.1016/j.lpm.2016.07.025.

29. Frank O, Luisada-Opper A, Sorrell MF, et al. Vitamin deficits in severe alcoholic fatty liver of man calculated from multiple reference units. Exp Mol Pathol. 1971;15(2):191-197. doi: 10.1016/0014-4800(71)90098-0.

30. Hoyumpa AM Jr. Mechanisms of thiamin deficiency in chronic alcoholism. Am J Clin Nutr. 1980;33(12):2750-2761. doi: 10.1093/ajcn/33.12.2750.

31. Leevy CM, Baker H, Tenhove W, et al. B-complex vitamins in liver disease of the alcoholic. Am J Clin Nutr. 1965;16(4):339-346. doi: 10.1093/ajcn/16.4.339.

32. Koike H, Mori K, Misu K, et al. Painful alcoholic polyneuropathy with predominant small-fiber loss and normal thiamine status. Neurology. 2001 Jun 26;56(12):1727-32. doi: 10.1212/wnl.56.12.1727.

33. Chen X, Levine JD. Mechanically-evoked C-fiber activity in painful alcohol and AIDS therapy neuropathy in the rat. Mol Pain. 2007 Feb 23;3:5. doi: 10.1186/1744-8069-3-5.

34. Narita M, Miyoshi K, Suzuki T. Involvement of microglia in the ethanolinduced neuropathic pain-like state in the rat. Neurosci Lett. 2007;414(1):21-25. doi: 10.1016/j.neulet.2006.10.062.

35. Miyoshi K, Narita M, Takatsu M, Suzuki T. mGlu5 receptor and protein kinase C implicated in the development and induction of neuropathic pain following chronic ethanol consumption. Eur J Pharmacol. 2007;562(3):208-211. doi: 10.1016/j.ejphar.2007.01.091.

36. McDonough KH. Antioxidant nutrients and alcohol. Toxicology. 2003;189(1-2):89-97. doi: 10.1016/s0300-483x(03)00155-0.

37. Dina OA, Barletta J, Chen X, et al. Key role for the epsilon isoform of protein kinase C in painful alcoholic neuropathy in the rat. J Neurosci. 2000;20(22):8614-8619. doi: 10.1523/JNEUROSCI.20-22-08614.2000.

38. Dina OA, Gear RW, Messing RO, Levine JD. Severity of alcohol-induced painful peripheral neuropathy in female rats: role of estrogen and protein kinase (A and Cε) Neuroscience. 2007; 145(1):350-356. doi: 10.1016/j.neuroscience.2006.11.053.

39. Jung ME, Gatch MB, Simpkins JW. Estrogen neuroprotection against the neurotoxic effects of ethanol withdrawal: potential mechanisms. Exp Biol Med (Maywood). 2005 Jan; 230(1):8-22. doi: 10.1177/153537020523000102.

40. Behse F, Buchthal F. Alcoholic neuropathy: clinical, electrophysiological and biopsy findings. Ann Neurol. 1977;2:95-110. doi: 10.1002/ana.410020203.

41. Levin OS, Shtul'man DR. Nevrologiya: spravochnik prakticheskogo vracha [Neurology: a handbook of a practical physician]. 12th ed. Moscow: MEDpress-inform; 2019. 880 p.

42. Golovacheva VA, Strokov IA. Treatment of diabetic and alcoholic polyneuropathy: opportunities and prospects of pharmacotherapy. Russkii meditsinskii zhurnal. 2014;(16):1193. (In Russ).

43. Levin OS. Polinevropatii: Klinicheskoe rukovodstvo [Polyneuropathies: a Clinical guide]. Moscow: MIA; 2011. 469 p.

44. Lauria G, Lombardi R, Camozzi F, Devigili G. Skin biopsy for the diagnosis of peripheral neuropathy. Histopathology. 2009 Feb;54(3):273-85. doi: 10.1111/j.1365-2559.2008.03096.x.

45. Kurushina OV, Barulin AE, Chernovolenko EP. Alcoholic polyneuropathy: ways of diagnosis and therapy. Meditsinskii sovet. 2019;(1): 58-63. (In Russ.)

46. Hamel J, Logigian EL. Acute nutritional axonal neuropathy. Muscle Nerve. 2018 Jan; 57(1):33-39. doi: 10.1002/mus.25702. Epub 2017 Jun 19.

47. Tackmann W, Minkenberg R, Strenge H. Correlation of electrophysiological and quantitative histological findings in the sural nerve of man. Studies on alcoholic neuropathy. J Neurol. 1977 Nov 1;216(4):289-99. doi: 10.1007/bf00314053.

48. Tredici G, Minazzi M. Alcoholic neuropathy. J Neurol Sci. 1975 Jul;25(3):333-46. doi: 10.1016/0022-510x(75)90155-0.

49. Blackstock E, Rushworth G, Gath D. Electrophysiological studies in alcoholism. J Neurol Neurosurg Psychiatry. 1972 Jun;35(3):326-34. doi: 10.1136/jnnp.35.3.326.

50. Mills KR, Ward K, Martin F, Peters TJ. Peripheral neuropathy and myopathy in chronic alcoholism. Alcohol Alcohol. 1986;21(4):357-62.

51. D'Amour ML, Bruneau J, Butterworth RF. Abnormalities of peripheral nerve conduction in relation to thiamine status in alcoholic patients. Can J Neurol Sci. 1991 May;18(2):126-8. doi: 10.1017/s0317167100031565.

52. Ono S, Oishi M, Takasu T. Central and peripheral motor conduction time in chronic alcoholics with polyneuropathy and/or spasticity. Funct Neurol. 1999;14(1):29-36.

53. Mellion ML, Silbermann E, Gilchrist JM, et al. Small-Fiber Degeneration in AlcoholRelated Peripheral Neuropathy. Alcohol Clin Exp Res. 2014 July;38(7):1965-1972. doi:10.1111/acer.12470.

54. Emelyanova AYu, Zinovyeva OE, Fedoseev SR, Misyuryaeva EV. Neurological complications of alcoholic disease and ways of their correction. Nevrologiya, neiropsikhiatriya, Psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3):124–8. (In Russ.) doi: 10.14412/2074-2711-2019-3-124-128.

55. Peters TJ, Kotowicz J, Nyka W, et al. Treatment of alcoholic polyneuropathy with vitamin B complex: a randomised controlled trial. Alcohol Alcohol. 2006 Nov-Dec;41(6): 636-42. Epub 2006 Aug 21. doi: 10.1093/alcalc/agl058.

56. Woelk H, Lehrl S, Bitsch R, Kö pcke W. Benfotiamine in treatment of alcoholic polyneuropathy: an 8-week randomized controlled study (BAP I Study). Alcohol Alcohol. 1998 Nov-Dec;33(6):631-8. doi: 10.1093/alcalc/33.6.631.

57. Anisimova EI. Benfotiamine efficacy in alcoholic polyneuropathy therapy. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2001;101(12): 32-6. (In Russ.).

58. Pizova NV. Clinical manifestations of nervous system impairments in diabetes mellitus. Meditsinskii Sovet. 2018;(9):104-11. (In Russ.).

59. Reed LJ, De Busk BG, Gunsalus IC, Hornberger CS. Cristalline alpha-lipoic acid: a catalytic agent associated with pyruvate dehydrogenase. Science. 1951 Jul 27;114(2952):93-4. doi: 10.1126/science.114.2952.93.

60. Rochette L, Ghibu S, Richard C, et al. Direct and indirect antioxidant properties of α-lipoic acid and therapeutic potential. Mol Nutr Food Res. 2013 Jan;57(1):114-25. doi: 10.1002/mnfr.201200608.

61. Kishi Y, Schmelzer JD, Yao JK, et al. Alpha-lipoic acid: effect on glucose uptake, sorbitol pathway, and energy metabolism in experimental diabetic neuropathy. Diabetes. 1999 Oct; 48(10):2045-51. doi: 10.2337/diabetes.48.10.2045.

62. Stevens MJ, Obrosova I, Cao X, et al. Effects of DL-alpha-lipoic acid on peripheral nerve conduction, blood flow, energy metabolism, and oxidative stress in experimental diabetic neuropathy. Diabetes. 2000 Jun;49(6): 1006-15. doi: 10.2337/diabetes.49.6.1006.

63. Ford I, Cotter MA, Cameron NE, Greaves M. The effects of treatment with alpha-lipoic acid or evening primrose oil on vascular hemostatic and lipid risk factors, blood flow, and peripheral nerve conduction in the streptozotocin-diabetic rat. Metabolism. 2001;50(8):868-875. doi: 10.1053/meta.2001.24914.

64. Sun LQ, Chen YY, Wang X, et al. The protective effect of alpha lipoic acid on Schwann cells exposed to constant or intermittent high glucose. Biochem Pharmacol. 2012 Oct 1;84(7): 961-73. doi: 10.1016/j.bcp.2012.07.005. Epub 2012 Jul 14.

65. Heitzer T, Finckh B, Albers S, et al. Benefficial effects of alpha-lipoic acid and ascorbic acid on endothelium-dependent, nitric oxide-mediated vasodilation in diabetic patients: relation to parameters of oxidative stress. Free Radic Biol Med. 2001 Jul 1;31(1):53-61. doi: 10.1016/s0891-5849(01)00551-2.



For citations:

Pizova N.V. «Masks» of alcoholic polyneuropathy. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(2):114-118. (In Russ.)

Views: 511

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)