Alcoholic peripheral neuropathy

Chronic alcoholism is associated with damage to the peripheral nerves, caused by a deficiency of vitamin B1 (thiamine) and a direct toxic effect of alcohol.

Clinical Features

• Alcoholic peripheral neuropathy affects sensory, motor and autonomic nerves.
• Sensory symptoms (numbness, burning, tingling, pain), and loss of vibration and position sense usually occur before motor symptoms (muscle weakness and wasting). Pain can be severe.
• The lower extremities and the feet are usually affected first, followed by the hands.
• Damage to autonomic nerves may result in abnormal pupil reactions and tachycardia (rapid heart rate). However, postural hypotension (fall in blood pressure on standing) and sphincter dysfunction (bladder and bowel) that can result from damage to autonomic nerves, is unusual.
• Onset is usually insidious and prolonged but can occasionally be rapid.

Treatment

Alcoholic peripheral neuropathy is treated by stopping alcohol intake together with administration of vitamin B1. Other treatments that may be considered include physiotherapy, occupational therapy and medication, for example Gabapentin and Amitriptylline, to treat the sensory symptoms.

Care and mobility needs

These depend upon the severity of the neuropathy and response to treatment. Advice should be sought from Medical Services.

Prognosis

The prognosis depends upon severity of the neuropathy and when treatment is initiated. A poor prognosis is associated with severe symptoms and delayed treatment. After treatment, symptoms may take weeks to resolve and in severe cases recovery may take months or be incomplete. Some people can be left with permanent painful neuropathy which does not improve with abstinence. Continued drinking or relapse is likely to worsen the symptoms.

All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.

Amended April 2009