Alcoholic Neuropathy: Symptoms, Causes, & Treatments

Why is Alcohol Toxic?

Excessive alcohol abuse is a global challenge. WHO (The World Health Organisation) states that over 4.5% of the world’s burden of disease and 4% of global deaths can be attributed to alcohol. [1]

The leading risk factor of death among males between the ages of 15 and 59 is alcohol, showing how much of a problem drinking in excess has become. [2]

Alcohol has a toxic effect on the body, its organs, tissue, and nervous system.

This is the consequence of the following: [3]

1. Alcohols metabolism to acetaldehyde
2. Formation of reactive oxygen and nitrogen species
3. Depletion of co-factors
4. Impairment in energy homeostasis

The sheer amount of alcohol consumed determines the level of toxicity. If the levels of alcohol consumption have become chronic, this may result in alcoholic neuropathy. This is a condition characterised by nerve damage from long-term alcohol abuse. [4]

Causes and Mechanisms Underlying Alcohol Neuropathy

The mechanisms behind alcoholic neuropathy are rarely understood due to its pathobiology, despite several explanations.

These suggestions have included (all due to alcohol consumption):

• Activation of spinal cord microglia
• Oxidative stress followed by radical nerve damage
• Activation of mGlu5 receptors in the spinal cord
• Activation of the sympathoadrenal and hypothalamo-pituitary-adrenal axis
• Nutritional deficiency (thiamine)
• Alcoholic neuropathy

Alcohol neuropathy has been found to be more prevalent in women compared to men, with greater severity and more rapid onset. [5]

Despite the unknown formation of alcohol neuropathy, all people that suffer from this condition have peripheral nerve damage.

These nerves can be found on the exterior of the brain and in the spinal cord, with the role to relay information between the brain and body.

Peripheral nerves have important motor and sensory functions, such as bowel and bladder control, walking, sex, limb movement, and speech.

The thiamine deficiency seen in most alcoholics appears to be a leading cause of alcohol neuropathy. Alcohol reduces the body’s ability to be able to absorb thiamine, causing malabsorption.

Furthermore, patients who consume an excessive amount of alcohol tend to lack general nutrition and vitamins.

This has led experts to believe alcohol neuropathy occurs through a combination of:

• Toxic effects of ethanol
• Nutritional deficiencies (thiamine deficiency)

The exact and precise amount of alcohol that causes alcoholic neuropathy is challenging to estimate, as everyone’s alcohol tolerance and reactions are different. The duration of alcohol use, amount consumed per sitting, and period of use all influence the development of this condition.

One study has suggested that if you consume over 100grams of alcohol per day over the course of many years, it is likely to lead to alcohol-related neuropathy.

10ml or 8grams of alcohol is equivalent to one unit of alcohol, the amount that an adult is able to process in one hour. It has been considered safe for people to drink 2 – 3 units a day, or around 21 units a week (not all in one sitting). [6]

Symptoms of Alcoholic Neuropathy

Alcoholic neuropathy is not life-threatening, in reference to morbidity. However, this condition can decrease the quality of life as it impacts movement and forms of sensation.

One of the noticeable symptoms of alcohol neuropathy is hyperalgesia and allodynia. Hyperalgesia is an abnormally heightened sensitivity to pain.

Allodynia is a condition that is characterised by a feeling of pain to a stimulus that normally does not cause any discomfort.

The other symptoms of alcoholic neuropathy are:

In the Limbs

• Numbness and tingling
• Burning
• Prickly or pins and needles
• Muscle spasms
• Muscle cramps
• Weakness and atrophy
• Loss of function
• Movement disorder

Other Symptoms

• Incontinence and constipation
• Diarrhoea
• Problems urinating
• Feelings of a full bladder after emptying
• Sexual dysfunctions
• Impotence
• Impaired speech
• Trouble swallowing
• Sweating and heat intolerance
• Vomiting and nausea
• Light-headedness
• Dizziness

Symptoms develop slowly, appearing over months and years. The abnormalities in sensory and motor functions lead to painful and uncomfortable symptoms that may be incapacitating. [7]

How is Alcoholic Neuropathy Diagnosed?

Once you begin to see any signs of alcohol neuropathy, get in touch with a doctor or any medical professional in order to get diagnosed. This involves being honest about your alcohol consumption and daily life, including diet and other aspects of living.

The tests that may identify alcoholic neuropathy include:

• A biopsy of nerves
• Nerve conduction test
• Neurological examination
• Small bowel and upper GI series
• Kidney test
• Thyroid test
• Liver function test
• Complete blood count (CBC)
• Electromyography
• Blood tests (searching for vitamin deficiency) – the nutrients that your doctor will test for include thiamine, niacin, folate, vitamins E, A, B6 and B12, biotin, and pantothenic acid.

The largest treatment for alcoholic neuropathy will include the decision to stop drinking alcohol. Treatment will primarily focus on alcohol abuse, such as rehabilitation (inpatient and outpatient) and therapy at a professional clinic.

Outside of alcohol use, doctors will focus on the characteristics and symptoms of alcoholic neuropathy. Management of this condition is critical as nerve damage can be completely debilitating.

Treatment plans may include:

• Vitamin supplements for nerve health, such as folate, thiamine, and other vitamins (implementing a balanced diet)
• Prescribed pain relief such as tricyclic antidepressants and anticonvulsants
• Physiotherapy aimed at muscle atrophy (physical therapy)
• Medication for urination and constipation
• In extreme cases, orthopaedic appliances for stability are offered to patients
• Safety equipment to prevent injury
• Medical stockings to prevent dizziness and help circulation

Usually, nerve damage is permanent and will only get worse if the drinking continues. If caught early, however, doctors and medical professionals are able to minimise nerve damage and chronic pain leading to disability.

Full recovery is possible in extremely mild cases, with intervention, alcohol abstinence, and a renewed diet.

Alcohol neuropathy is a form of nerve damage caused by a combination of:

• Vitamin deficiency
• Excessive drinking / chronic alcohol consumption
• Alcohol use disorder

This health condition has a variety of treatment options, but the severity of the condition is dependent on alcohol intake and lifestyle.

Alcohol-related nerve damage may be reversible if it is caught early enough, and symptoms will be eased. The key issue to address is alcohol abuse, involving receiving adequate addiction treatment.

References

[1] World Health Organization . Global status report on alcohol and health. WHO Press; Geneva, Switzerland: 2011.

[2] Zaridze D, Brennan P, Boreham J, Boroda A, Karpov R, Lazarev A, et al. Alcohol and cause-specific mortality in Russia: a retrospective case-control study of 48,557 adult deaths. Lancet. 2009;373:2201–2214.

[3] Zakhari S. Overview: how is alcohol metabolized by the body? Alcohol Res Health. 2006;29:245–254.

[4] 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. PMID: 21988193; PMCID: PMC3370340.

[5] Ammendola A, Gemini D, Iannaccone S, Argenzio F, Ciccone G, Ammendola E, Serio L, Ugolini G, Bravaccio F. Gender and peripheral neuropathy in chronic alcoholism: a clinical-electroneurographic study. Alcohol Alcohol. 2000;35:368–71.

[6] https://www.leicestershospitals.nhs.uk/patients/patient-welfare/smoking-and-drinking/alcohol-awareness/how-much-is-too-much/#:~:text=The%20safe%20limit%20for%20men,bottles%20of%20wine%20a%20week.

[7] Koike H, Sobue G. Alcoholic neuropathy. Curr Opin Neurol. 2006;19:481–6.

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