Alcoholic Neuropathy

What is the definition of Alcoholic Neuropathy?

Alcoholic neuropathy is damage to the nerves that results from excessive drinking of alcohol.

What are the alternative names for Alcoholic Neuropathy?

Neuropathy - alcoholic; Alcoholic polyneuropathy

What are the causes for Alcoholic Neuropathy?

The exact cause of alcoholic neuropathy is unknown. It likely includes both a direct poisoning of the nerve by the alcohol and the effect of poor nutrition associated with alcoholism. Up to half of long-term heavy alcohol users develop this condition.

In severe cases, nerves that regulate internal body functions (autonomic nerves) may be involved.

What are the symptoms for Alcoholic Neuropathy?

Symptoms of this condition include any of the following:

• Numbness in the arms and legs
• Abnormal sensations, such as "pins and needles"
• Painful sensations in the arms and legs
• Muscle problems, including weakness, cramps, aches, or spasms
• Heat intolerance, especially after exercise
• Erection problems (impotence)
• Problems urinating, incontinence (leaking urine), feeling of incomplete bladder emptying, difficulty beginning to urinate
• Constipation or diarrhea
• Nausea, vomiting
• Problems swallowing or talking
• Unsteady gait (walking)

Changes in muscle strength or sensation usually occur on both sides of the body and are more common in the legs than in the arms. Symptoms usually develop gradually and become worse over time.

What are the current treatments for Alcoholic Neuropathy?

Once the alcohol problem has been addressed, treatment goals include:

• Controlling symptoms
• Maximizing ability to function independently
• Preventing injury

It is important to supplement the diet with vitamins, including thiamine and folic acid.

Physical therapy and orthopedic appliances (such as splints) may be needed to maintain muscle function and limb position.

Medicines may be needed to treat pain or uncomfortable sensations. People with alcoholic neuropathy have alcohol use problems. They will be prescribed the smallest dose of medicine needed to reduce symptoms. This may help prevent drug dependence and other side effects of chronic use.

Positioning or the use of a bed frame that keeps the covers off the legs may help reduce pain.

People with lightheadedness or dizziness when standing up (orthostatic hypotension) may need to try several different treatments before finding one that successfully reduces their symptoms. Treatments that may help include:

• Wearing compression stockings
• Eating extra salt
• Sleeping with the head elevated
• Using medicines

Bladder problems may be treated with:

• Manual expression of urine
• Intermittent catheterization (male or female)
• Medicines

Impotence, diarrhea, constipation, or other symptoms are treated when necessary. These symptoms often respond poorly to treatment in people with alcoholic neuropathy.

It is important to protect body parts with reduced sensation from injury. This may include:

• Checking the temperature of bath water to prevent burns
• Changing footwear
• Frequently inspecting the feet and shoes to reduce injury caused by pressure or objects in the shoes
• Guarding the extremities to prevent injury from pressure

Alcohol must be stopped to prevent the damage from getting worse. Treatment for alcoholism may include counseling, social support such as Alcoholics Anonymous (AA), or medicines.

What is the outlook (prognosis) for Alcoholic Neuropathy?

Damage to nerves from alcoholic neuropathy is usually permanent. It is likely to get worse if the person continues to use alcohol or if nutritional problems are not corrected. Alcoholic neuropathy is usually not life-threatening, but it can severely affect quality of life.

When should I contact a medical professional for Alcoholic Neuropathy?

Call for an appointment with your provider if you have symptoms of alcoholic neuropathy.

How do I prevent Alcoholic Neuropathy?

The only way to prevent alcoholic neuropathy is not to drink excessive amounts of alcohol.

REFERENCES

Katirji B. Disorders of peripheral nerves. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 107.

Koppel BS. Nutritional and alcohol-related neurologic disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 416.