Alcoholic polyneuropathy of the hands and lower extremities: symptoms and treatment. Alcoholic neuropathy

Polyneuropathy is one of the most common complications alcoholic illness. Currently there are 3 main forms alcoholic polyneuropathy: acute, subacute and chronic. They have different clinical presentations and developmental mechanisms. Neurologists at the Yusupov Hospital use modern methods studies of patients suffering from alcoholic polyneuropathy. Complex therapy is carried out effectively medicines which have minimal side effects.

During treatment, patients stay in comfortable rooms at the neurology clinic. They are provided by individual means personal hygiene and dietary nutrition. The clinic staff guarantees the anonymity of treatment. Tactics of treatment of patients with severe disease candidates and doctors medical sciences, doctors of the highest category discuss at a meeting of the expert council. Leading specialists in the field of neurology of the peripheral nervous system collectively develop treatment tactics for the patient.

For chronic alcohol intoxication process degeneration occurs nerve cells– axons. It is accompanied by secondary myelinopathy in the form of segmental demyelination (loss of myelin) and remyelination (restoration of the myelin sheath of the nerve). Chronic toxic polyneuropathy develops more often. It is caused by the direct toxic effects of ethanol and its metabolic products, which affect both myelin-covered and non-myelin-covered thin nerve fibers. The latter provide temperature and pain sensitivity and provide vegetative-trophic functions.

Toxic effect of alcohol on autonomic and somatic nerve fibers. depends on the dose of alcohol consumed. Average daily dose alcohol over 100 g significantly increases the likelihood of developing alcoholic polyneuropathy. Heaviness clinical manifestations diseases directly depends on the total dose of ethanol.

Scientists suggest that toxic effect ethanol and its breakdown products into neurons is carried out through activation of glutamate receptors in the spinal cord, stimulation of glutamate neurotoxicity, activation of free radical lipid peroxidation, and increased production of hormones that cause inflammation. Ethanol helps to reduce the production and disrupt the normal configuration of proteins of the cellular skeleton of the nerve fiber, slowing down axonal transport. Many representatives of the Asian race are impaired normal exchange ethyl alcohol due to the presence of a mutation in the gene that encodes the production of the enzyme aldehyde dehydrogenase. As a result, the level of toxic acetaldehyde in the human body can exceed the norm by more than 20 times.

Acetaldehyde is capable of forming complexes with normal proteins, converting them into proteins that have a toxic effect on cells. They affect neurons, muscle and liver cells, leading to the development of liver cirrhosis. This further aggravates the severity of toxic alcoholic polyneuropathy.

Ethanol activates microglial cells spinal cord, increases the functional activity of the sympathoadrenal and hypothalamic-pituitary-adrenal systems. These changes play a significant role in the formation of increased sensitivity in the spinal cord and in the development of neuropathic pain syndrome. Pain syndrome occurs under the influence of weak stimuli that previously did not cause pain. Neurons of the peripheral nervous system are more vulnerable to the effects of toxic products of alcohol metabolism than neurons of the central nervous system, which are protected by the blood-brain barrier.

Symptoms of alcoholic polyneuropathy

In patients with toxic alcoholic polyneuropathy, predominantly weakly myelinated fibers are affected. IN clinical picture diseases are dominated by autonomic and sensory disorders. In most patients, the earliest clinical symptoms of the disease are:

paresthesia (sensations of “tingling”, “crawling”);
numbness in the distal parts lower limbs;
periodic convulsive twitching of the muscles of the legs and feet.

At the same time or somewhat later, a “burning” feeling is added, neuropathic pain in the extremities, which is excruciating “burning”, “shooting” in nature, intensifies at night. Syndrome may develop restless legs. Its clinical basis is an imperative desire to move the limbs due to unpleasant sensations in them, more pronounced at night.

Toxic alcoholic polyneuropathy progresses over several months or years. Symptoms of the disease begin in the distal lower extremities, spread to the proximal legs, lower torso, and in more severe cases, to the upper extremities. In this clinical form, the sensory defect predominates over the motor one. In half of the patients, even with long term movement disorders do not occur. In other patients, weakness in the extensors of the feet and fingers may develop, and hypotrophy (decreased volume) of the muscles of the distal legs may develop. With a long course of the disease, weakness appears in the proximal parts of the legs and hands, and difficulty walking occurs.

In alcoholic polyneuropathy it is often observed autonomic dysfunction. It manifests itself with the following symptoms:

increased sweating of the feet and palms and soles;
trophic disorders;
color changes skin;
swelling;
orthostatic hypotension(decrease in blood pressure when changing body position);
rapid heartbeat at rest;
constipation, upset stomach.

Violation autonomic innervation internal organs further aggravates metabolic disorders caused by the toxic effects of ethanol and its metabolites. Peripheral autonomic failure increases the risk of sudden death in patients due to silent forms of myocardial infarction.

Neurologists, during an objective examination of patients, detect disturbances in pain and temperature sensitivity of the polyneuropathic type in the form of a decrease or increase in sensitivity. In some cases, signs of allodynia develop (pain due to exposure to irritants that usually do not cause it). In the early stages of the disease, the Achilles reflexes fade or disappear. With further progression of the pathological process, knee reflexes and tendon reflexes in the hands decrease or disappear, and weakness and wasting of the muscles of the limbs develops.

Along with chronic alcoholic polyneuropathy, neurologists at the Yusupov Hospital observe patients whose symptoms of the disease develop acutely or subacutely. In the mechanism of development of this form of alcoholic polyneuropathy, the leading role is played by deficiency of vitamin B1 (thiamine) and other B vitamins. When drinking alcohol, thiamine deficiency in the body develops in several ways. Ethanol reduces the absorption of vitamin B1 small intestine, reduces the supply of thiamine in the liver, reduces its intracellular phosphorylation. This leads to a decrease in the formation of the active form of the vitamin - thiamine diphosphate.

In most patients suffering chronic alcoholism, inadequate, unbalanced nutrition is observed, diseases develop gastrointestinal tract which lead to malabsorption. As a result of vitamin B1 deficiency, the incorporation of lipids into myelin is reduced, the biosynthesis and exchange of neurotransmitters is disrupted, and zones with lactic acidosis and intracellular calcium accumulation are formed in neurons. They enhance the neurotoxic effect of alcohol.

Diagnosis of alcoholic polyneuropathy

The clinical symptoms of alcoholic polyneuropathy are nonspecific, therefore, when making a diagnosis, neurologists at the Yusupov Hospital evaluate the patient’s drug status and nutrition. Laboratory indicators reflect the degree of damage to the liver tissue due to alcohol intoxication. In patients it is determined increased level liver transaminases (aspartate aminotransferase and alanine aminotransferase) or gamma-glutamyl transpeptidase. To clarify the presence of a deficiency of thiamine and other B vitamins, their concentrations in the blood serum are examined. Thiamine deficiency is confirmed by a decrease in transketolase activity of erythrocytes. Study cerebrospinal fluid does not reveal changes.

The main method for diagnosing alcoholic polyneuropathy is electroneuromyography. This innovative research method allows you to determine the level, nature and extent of damage peripheral nerves. Alcoholic polyneuropathy is characterized by generalized symmetrical sensory-motor, predominantly distal axonopathy with signs of secondary myelinopathy.

When conducting stimulation electroneuromyography, a decrease in the amplitude of action potentials of sensory and motor nerves. This reflects damage to the axial cylinder of the nerve fiber - axonopathy. There is a decrease in the speed of propagation of excitation along sensitive and motor fibers all nerves of the limbs, which is a sign of myelinopathy. These changes may be observed in patients who do not have clinical signs of alcoholic polyneuropathy.

In diagnosing various clinical forms of alcoholic polyneuropathy, neurophysiologists at the Yusupov Hospital use needle electromyography. It allows you to quantitatively assess the parameters of action potentials of motor units and identify signs of denervation in the muscle that are caused by axon damage - fibrillation potentials, positive sharp waves.

The electroneuromyography method allows you to assess the condition of thick myelinated fibers of peripheral nerves. To diagnose damage to thin fibers of peripheral nerves in the presence of alcoholic polyneuropathy, doctors functional diagnostics The following methods are used:

quantitative sensory testing;
laser evoked potentials;
evoked potentials to thermal stimulation;
study of intraepidermal nerve fibers.

In cases that are difficult to diagnose, neurologists collectively establish a diagnosis and take an individual approach to the choice of treatment method.

Treatment of alcoholic polyneuropathy of the lower extremities

Considering the multifactorial mechanisms of the development of alcoholic polyneuropathy, combined damage to the liver and gastrointestinal tract, neurologists at the Yusupov Hospital provide complex therapy for the disease. Patients are observed by a neurologist, therapist, hepatologist, and gastroenterologist. In most cases, the prognosis for alcoholic polyneuropathy is favorable. Neurological functions are restored, but patients retain residual effects of peripheral nerve damage. Treatment of alcoholic polyneuropathy requires a long period of time because axonal regeneration and restoration of collateral neurons are slow.

Required condition effective treatment alcoholic polyneuropathy is complete failure from drinking alcoholic beverages, restoration of full balanced nutrition With sufficient quantity vitamins and protein, physical rehabilitation patient.

To relieve pain in alcoholic polyneuropathy, neurologists use antidepressants and anticonvulsants, as well as their combinations. Among antidepressants, the most effective drugs are tricyclic antidepressants (amitriptyline) and serotonin and norepinephrine reuptake inhibitors (venlafaxine and duloxetine). An alternative is therapy with anticonvulsants – pregabalin, gabapentin.

In the treatment of alcoholic polyneuropathy, doctors at the neurology clinic use drugs from the group of antioxidants - alpha lipoic acid. It directly removes free radicals, restores antioxidants (glutathione, vitamins E and C; reduces the production free radicals. Considering that a decrease in the concentration of thiamine in the blood is observed in 40–80% of people with chronic alcoholism, doctors at the Yusupov Hospital prescribe combination preparations of B vitamins to patients suffering from alcoholic polyneuropathy. They include thiamine, pyridoxine (vitamin B 6) and cyanocobalamin ( vitamin B 12).

In order to establish a diagnosis and undergo an effective course of treatment for alcoholic polyneuropathy, call the Yusupov Hospital. A contact center specialist will make an appointment with a neurologist in convenient time.

Bibliography

ICD-10 ( International classification diseases)

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, defined by the provisions of Art. 437 Civil Code of the Russian Federation. For getting accurate information contact the clinic staff or visit our clinic. List of services provided paid services indicated in the price list of the Yusupov Hospital.

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, defined by the provisions of Art. 437 Civil Code of the Russian Federation. For accurate information, please contact the clinic staff or visit our clinic.

Alcoholism gradually, painfully destroys a person. Ethanol is a very toxic substance, and its breakdown products cause irreparable damage to all body systems. Alcoholism leads to weakened immunity, deterioration mental health, complete personal degradation.

– one of dozens of diseases that arise from alcohol abuse.

– dangerous disease, manifested in intoxication of the nervous system. But not only alcoholism can cause polyneuropathy - diabetes mellitus or an infectious infection can provoke this disease.

In the first two cases, the disease develops in stages, with a gradual worsening of symptoms. In approximately 10% of cases, polyneuropathy develops extremely sharply and can cause serious damage to the body in just a few days. But do not be upset in advance - medical intervention carried out on time - in the early stages of the disease, will allow you to completely cope with it. Otherwise, it may become chronic.

Alcoholic polyneuropathy according to ICD-10 has code G62.1

Symptoms of alcoholic neuropathy

Symptoms appear slowly, so neuropathy is not easy to identify. The main symptom of the disease is damage to the patient’s nervous system.

At first, a person experiences slight numbness in the fingers and toes. After that discomfort spread further to the limbs. Blood circulation deteriorates, subsequently the patient may feel cold in the legs.

The muscles gradually atrophy, their visual decrease can be observed with your own eyes. Severe cramps become more frequent, especially at night. The skin on the lower extremities turns blue and acquires a “dead” color.

Further development of the disease leads to complete paralysis of all limbs. As a result, the person cannot move and becomes physically incapacitated. Often from this moment on, most patients spend all their time without getting out of bed.

On this destructive effect alcoholic polyneuropathy of the lower extremities does not end - the body continues to weaken, the person may experience phantom pain, as often happens after amputation. Mental health disorders can also make the disease worse.

Neuropathy is also not limited to problems with the limbs - its influence extends to the visual, respiratory functions and cardiovascular system. But first of all, it is the patient’s legs that are at risk - everyday deterioration increasingly interferes with motor function.

Regardless of the causes of neuropathy, its main symptoms are similar: cramps, gradual muscle atrophy, and, as a result - paralysis, development of further side symptoms may differ in individual situations.

During medical intervention and treatment of the disease, the symptoms gradually go back to reverse order, although in some situations, some primary symptoms may remain after treatment.

Diagnosis of alcoholic polyneuropathy

First of all, in medical institution The doctor collects information about the patient, his habits, and lifestyle. A check is carried out for extraneous factors, diseases that could provoke polyneuropathy, after which the patient is examined by a neurologist to detect primary signs diseases.

Electroneuromyography(ENMG) is a procedure that allows you to determine the degree of damage to the nervous system. It reveals how far the disease has spread, whether peripheral nerves are affected and what stage of the disease is acute or chronic. ENMG can detect muscle dystrophy, carpal tunnel syndrome, amyotrophic syndrome. Regular electroneuromyography will help in monitoring treatment and monitoring the body’s recovery process.

In some cases, they carry out biopsy of nervous system tissue. This more complex procedure can reveal a number of other serious illnesses, and more accurately diagnose polyneuropathy. These methods will quickly identify the disease, its degree, spread and complications, which will help to begin treatment as quickly as possible.

In most cases, treatment of alcoholic polyneuropathy takes place at home. On late stages development of the disease, when the patient’s life is at risk, the course of treatment is carried out in a hospital.

Depending on the cause of the disease, various etiological methods are used to determine the first steps in recovery. If this reason is alcoholism, then the main factor, without which everything further treatment will be useless - complete abstinence from alcohol. Namely, it is necessary to completely and forever give up alcohol, even in small quantities.

Unfortunately, it will be impossible for a person who abuses alcohol, especially for a long time, to get rid of this problem on his own. addiction. The service here will include the help of a psychotherapist, coding methods and support from relatives and friends. Complex use These factors minimize the likelihood of breakdowns.

The next step towards returning to the human state is to resume correct mode And healthy image life. Thoughtful daily schedule healthy eating and physical activity will significantly speed up the patient’s recovery. For alcoholic neuropathy, it is necessary to focus on vitamin-rich and protein food. But you shouldn’t rely on your own knowledge for everything - make up detailed diet It is necessary individually for each person and only a doctor can do this.

Treatment with drugs

The above factors are combined with medication treatment.

In the treatment of alcoholic neuropathy, a number of drugs are used, which are divided into several main groups:

Vitamin complex. It is important for the patient to replenish the lack of vitamin B in the body. The drugs Pentovit and Complivit, which have a positive effect on the nervous system, will help with this.
Neurotropic drugs.
Nootropic drugs. They help develop mental activity, reduce the effect of toxins on the brain and improve mental condition patient (Piracetam, Phenibut, Glycine).
Antidepressants. This type of drugs also has a positive effect on the psyche and contributes to a person’s complete abstinence from alcohol (Amitriptyline).
Metabolic drugs. Improve metabolism. They are taken by patients during recovery in a comprehensive manner, together with physiotherapy.

In case of liver damage, hepatoprotective drugs and antioxidants may be prescribed for general strengthening body. Additionally, you can use recipes traditional medicine. This is a tincture of cloves, milk thistle seeds, olive oil, and carrot juice.

Non-drug treatment of neuropathy

Physiotherapy and related procedures play an important role in the treatment of the patient. Electrical stimulation spinal cord and nerve fibers are often included in this category. Even procedures such as ordinary massage, physiotherapy and acupuncture.

Magnetic therapy is widely practiced in our country, although there is no exact scientific confirmation of the effectiveness of this method. Only as a additional means treatment magnetotherapy is beneficial, although she has her fans and positive reviews. In US clinics, the use and sale of all products related to magnetotherapy is prohibited at the state level.

Emotional support– both therapeutic and household level important factor recovery. A calm everyday atmosphere, a change of environment and new acquaintances will accelerate drug treatment and will be a good prevention of alcoholic neuropathy.

Fulfillment of conditions for prevention: exclusion of alcohol from life, visiting health centers, regular rest and minimized stressful situations will make you forget about the disease.

There are numerous cases where patients in critical condition those on the verge of disability were fully restored.

Complications of alcoholic neuropathy

Nervous system - extremely complex structure human body. She is responsible for correct work organs, mental and motor abilities, genesis, and also affects other body systems. Accordingly, if the nervous system is disrupted and damaged, the entire body will suffer: organ failure and even complete cardiac arrest are possible. The disease can affect various nerves, for example, the optic nerve.

Muscle atrophy in the later stages can lead to permanent and irreversible disability. Problems with respiratory system will also make themselves felt. If the patient continues to drink alcohol in the later stages, then it is likely sharp deterioration memory, mental abilities, and in the end this will lead to dementia.

This is a neurological disease in which there is damage to the peripheral nerves. According to research, this disease is observed in 85% of people suffering from alcohol dependence. Both men and women can suffer from the disease.

Causes

Experts identify quite a few reasons why alcoholic polyneuropathy can develop. Most common cause is constant toxic effects ethanol products on the body, in particular on nerve endings.

This effect inhibits metabolic processes, resulting in disruption of blood flow and nutrients to nerve impulses.

The central nervous system also suffers from the negative effects of acetaldehyde, a breakdown product of ethyl alcohol. Experts say that the greatest danger to health is posed by low-quality alcohol, since it may contain prohibited substances. chemical compounds, leading to irreversible processes in the body.

In the case of long-term alcohol consumption, a person experiences severe liver dysfunction, which is a link with polyneuropathy. The immune system is also greatly affected by ethanol, in the body with high speed Antibodies develop that inhibit their own nerve tissue.

Often, alcoholic polyneuropathy develops due to a deficiency of vitamin B in the body, the absence of which occurs when there is a small amount of nutrients supplied and their poor absorption into the intestines.

If there is a deficiency of thiamine, then alcohol cannot completely leave the body, which causes it to last for a long time. Negative influence to all organs.

If a person is heavily intoxicated and lies in the same position for a long time, compression of some internal organs begins and the nerve is damaged. Other reasons why the disease develops are excessive hypothermia, ingestion of harmful substances, viruses.

Forms

The disease progresses in different ways; it also occurs due to various reasons, from here experts have identified several forms of alcoholic polyneuropathy.

Sensory- characterized by significant pain in the extremities, a person feels constant chills in the feet, numbness, sometimes burning, cramps in the calves often occur, and it can even be painful to touch the feet in some places. There is also a loss of sensation in the palms and soles; the patient may feel dull pain. Sensory form occurs as a result of a violation of the vegetative-vascular system, excessive marbling and acrocyanosis can be observed on the skin, and weakness is noted in the tendons.

Motor. With this form, a person experiences a disorder of the peripheral nerves. The lower extremities, in particular the peroneal and tibial nerves, are also affected. If the tibial nerve is damaged, a person cannot bend the foot normally, move the toes, cannot bend the foot inward, or walk on the toes. Violation peroneal nerve leads to the inability to straighten the feet and fingers. The muscles in this area atrophy, and hypotonia of the feet occurs.

Mixed. If a person has mixed alcoholic polyneuropathy, then disorders of the motor and sensory apparatus occur simultaneously. The patient becomes severely numb in the extremities, complete paralysis of the feet and hands occurs, severe or mild pain, and there is also a decrease or increase in sensitivity nerve endings, the extensor function suffers to a greater extent.

Atactic. The patient experiences a pronounced disturbance in gait, coordination suffers greatly, the legs and arms go numb, they feel practically nothing, and when pressing on the sole of the foot or on the palm, a stabbing pain is felt.

The disease is also divided into chronic and acute according to its course:

The chronic form is characterized by the fact that the disease develops slowly, and pathology gradually develops in the extremities. This form occurs most often, usually a person begins to suffer after a year of alcohol dependence.
Acute form develops quickly, but is quite rare. To the person for complete atrophy limbs, you just need to remain intoxicated for a month and a half.

Stages:

The first stage is characterized by the absence of symptoms of the disease, the clinical picture of the disease is also not visible, polyneuropathy can only be detected if necessary tests, undergo some examinations.
The second stage is easily identified by examination by a doctor, as well as based on complaints from the patient. There are no visible limb defects yet.
The third stage is expressed by a visual change in the limbs, pain, numbness, the person cannot walk normally.

Alcoholic neuropathy: symptoms and early diagnosis

The first thing a person feels is weakness in the muscles, usually manifesting itself in the morning after sleep, first the lower limbs go numb, and after a few minutes the arms begin to go numb. In some cases, numbness affects all limbs at once. The patient's tendon reflex first sharply decreases, after which it completely stops, the Achilles reflex is most susceptible, and muscle tone deteriorates.

Alcoholic neuropathy in its advanced form is manifested by symptoms such as: muscle weakness, paresis of the lower extremities, paralysis of the hands or feet, a person may not feel objects.

Sometimes the patient may complain of worsening visual reflexes. All of the listed signs of the disease are not permanent, they can last for several days, then completely disappear for one or two days, then recur. At the last stage, urination worsens, the person suffers nervous disorders, breathing is impaired, tachycardia, bradycardia, arrhythmia appears, drops sharply arterial pressure. A person can feel pain even in such forms of the disease when there is enough vitamin B and it settles in the foot. The nature of the pain is aching, burning sensations appear.

Along with this, a person’s gait is disturbed due to the fact that the feet become too sensitive, the foot cannot be bent inward, marbling, cyanosis, tingling, numbness in the calves, and cramps are visible on the legs.

Alcoholic neuropathy is not the only disease in which severe numbness of the limbs occurs; there are clones of this disease, namely diabetic polyneuropathy:

Diabetic polyneuropathy- characterized by blockage blood vessels in the limbs. A person with this disease, depending on the stage, feels periodic numbness in the hands or feet, the muscles become weak, and the long sciatic, femoral, and ulnar nerves are affected. People with diabetes feel the same pain in their legs as alcoholics; they experience redness of the skin, cyanosis of the feet, the skin becomes dry, ulcers and rotting wounds form. Such patients should not drink alcohol under any circumstances. This disease is scary because, unlike alcoholic polyneuropathy, diabetic polyneuropathy cannot be cured; it progresses slowly.
Neuropathy of the lower extremities— the disease is characterized by a constant attack of numbness in the extremities, especially after a long walk, at which time the legs begin to break out, twist, and you want to constantly touch and massage them. This occurs as a result of compression of the peripheral nerves.
Upper limb neuropathy- the disease is similar to neuropathy of the lower extremities, the only difference is that with the first disease several nerves can be affected simultaneously, which can lead to temporary loss of sensitivity in the hands.

Early diagnosis

In order to identify the disease early stages the patient must have symptoms such as tendon laxity, muscle weakness; only on the basis of the clinical picture of the first signs can an analysis of the disease be carried out. This usually occurs when the patient is examined by a doctor at the first appointment.

Electroneuromyography allows you to identify the first signs of the disease, determines how severely the disease has developed, and whether the patient has nerve inflammation. For another examination, your doctor may order a nerve fiber biopsy. Such an examination must be done to exclude other types of polyneuropathy.

Alcoholic neuropathy and treatment principles

The disease can appear only after prolonged drinking. Depending on how severe the symptoms of the disease are and with what complications all this occurs, appropriate treatment is prescribed.

Alcoholic neuropathy is most effectively treated at an early stage. Specialists at appointment various drugs First of all, they try to restore the lost function of nerve endings and improve blood circulation in this area. In this case, the doctor needs to be especially careful in prescribing medications to avoid allergies.

The following drugs are prescribed:

Among non-drug methods Physiotherapy is distinguished, in this case electrical stimulation of nerve endings occurs. The doctor also prescribes massage to quickly restore muscle activity. You should engage in health-improving physical exercises and take acupuncture courses.

Traditional treatment

Folk remedies are good for complex treatment diseases. There are a large number of recipes for this disease; let’s look at the most effective ones. You can make a cocktail based on fresh carrot juice(100 g) add one yolk, a few drops olive oil, two teaspoons of honey.

The ingredients are mixed in a blender and then consumed twice a day before meals. Infusion helps well bay leaf and fenugreek seeds (3 spoons). The mixture is brewed in a thermos for four hours.

Drink the infusion twice a day. This medicine helps speed up blood circulation in the vessels and normalizes sugar levels. Topically, you can lubricate the limbs with olive oil with the addition of dry St. John's wort herb. The herb is poured with hot oil, left for 15 hours, and filtered. You can use this product to apply compresses to your feet.

Forecast

Alcoholic neuropathy is highly treatable in the early stages. In advanced cases, you can become disabled, which is why it is so important to visit a specialist at the first symptoms of the disease. The effect of treatment is observed in those patients who sought help in time. You need to be patient, since the treatment will be long and persistent, you will need to eat right, and most importantly, not drink a drop of alcohol.

Alcoholic polyneuropathy can cause a number of complications, namely:

It should be remembered that at the first symptoms of this terrible disease, you need to see a doctor, otherwise you may lose your limbs for the rest of your life.

Long-term and continuous abuse of alcohol leads not only to the complete degradation of a person’s personality, but also affects the emergence of various diseases internal organs. Alcoholic polyneuropathy is one of these ailments; according to statistics, it occurs in 10% of patients suffering from alcohol dependence, regardless of whether it is a woman or a man.

Causes of development of alcoholic polyneuropathy

The toxic effect of alcohol breakdown products adversely affects the peripheral nervous system, disrupts metabolic processes and transmission of impulses, which becomes the basis for the symptoms of the disease. Pathological changes affect all parts of the spinal cord and brain.

Polyneuropathy from alcohol abuse develops in the last stages of the disease; its causes are:

Toxic effects of ethyl alcohol and its breakdown products on nerve fibers;
Deficiency of the B vitamin group. The deficiency of this group of vitamins is caused by monotonous diet, impaired functioning of liver cells and decreased absorption of nutrients from the intestinal mucosa. A small amount of thiamine does not allow alcohol to be fully oxidized, which only enhances its toxic effect and reduces the rate of metabolic processes.
Disruption of microcirculation in the structure of the nerve fiber.

The risk of polyneuropathy increases several times when consuming surrogate alcohol, various denatured alcohols and chemical alcohol-containing liquids.

Such liquids have the most toxic effect on the liver, due to which B vitamins are quickly destroyed and complete violation metabolism.

Course of the disease

Alcoholic polyneuropathy develops gradually in most patients, but due to constant exposure to alcohol, the person does not pay attention to the appearance of the first clinical signs.

The acute onset of the disease causes the consumption of large doses of alcohol over several days.

Patients begin to pay attention to their health when severe weakness in the legs and inability to move appears.

Very often, alcoholic polyneuropathy is a harbinger of a more serious disease such as
, which is very difficult to treat.

Alcoholic polyneuropathy of the lower extremities is the most common manifestation of the disease in the initial stage.

Complaints of patients with alcoholic polyneuropathy

The patient can only pay attention to the fact that health problems have appeared at the initial stage of polyneuropathy when he is sober. Typically, patients experience the following symptoms:

Convulsive contraction of the muscles in the toes.
Numbness and pins and needles in the extremities are paresthesias that appear after a night's sleep. Sensation in the legs is restored in a few minutes or hours.
Pain in the feet calf muscles Oh. The pain first appears at night and becomes constant as the disease progresses.
A characteristic symptom is pain and discomfort with slight palpation of the calf muscles.
Painful cramps in the leg muscles often develop.
The lower extremities periodically freeze even on summer days.
As the disease progresses, persistent weakness occurs in the legs and then in the arms.
IN in rare cases The patient complains of oculomotor disorders.

Clinical signs diseases increase as they become involved in pathological process All more nerve fibers. Symptoms of the disease may also undergo reverse development subject to complete abstinence from alcohol-containing liquids.

Manifestations of alcoholic polyneuropathy

Movement disorders come to the fore in alcoholic polyneuropathy. A cock's gait appears due to dysfunction of the extensor muscles in the foot.

Atrophy of the calf muscles develops rapidly, which is manifested by weight loss of the lower extremities. The arm muscles are included in this pathological process much later than the leg muscles.

Due to sensory impairment, the patient feels that the floor surface has become soft.

Both the structure and color of the skin changes - the limbs become marbled in color, the skin is dry, the fragility of nails increases, excessive sweating may occur, hair on the legs disappears, and at the end of the disease appear trophic ulcers, swelling.

Paresis and paralysis at the initial stage last for a short period of time, then they can significantly limit the patient’s mobility.
As the toxic damage to the nerve fibers continues, the vagus nerve is affected, resulting in shortness of breath and tachycardia.
A peculiarity of the course of polyneuropathy of alcoholic origin is its combination with amnestic syndrome, which is manifested by a lack of memory for current events, disorientation in space and time.
During the examination, the doctor pays attention to a violation of sensitivity in the calf muscles; in the arms and legs, this is recorded as the absence of reflexes in the area of putting on gloves and socks.
Nerve damage begins with lower sections and gradually spread to the whole body. This feature explains the appearance of the first symptoms of the disease in the lower extremities.

Alcoholic polyneuropathy must be distinguished from diabetic polyneuropathy. Diabetic polyneuropathy has similar clinical symptoms, sometimes is the first sign diabetes mellitus. The diagnosis is made on the basis of blood tests and instrumental examinations.

Treatment of alcoholic polyneuropathy

Success in the treatment of alcoholic polyneuropathy in general and in the treatment of polyneuropathy of the lower extremities depends on how much and how quickly the patient can stop drinking alcohol.

Drug treatment consists of groups of drugs used in courses. First of all this:

Prescriptions of thiamine and other B vitamins in injection and tablet form. The complex of vitamins is contained in such medicines, like Trigamma, Kombilepen, Neurorubin - forte.
Drugs that improve microcirculation and metabolic processes in the body. From modern medicines This group includes Thioctacid, Dialipon, Thiolepta.
At pain syndrome anti-inflammatory drugs and analgesics diclofenac, ibuprofen, baralgin, smazgan are used.

Help you recover faster motor sphere able and traditional medicine, about which you can read in more detail, used in conjunction with medications prescribed by a doctor.

Vitamin cocktail is prepared from one fresh chicken egg, two tablespoons of honey and olive oil. This mixture is whipped and 100 grams of fresh carrot juice is added to it. The cocktail is taken twice a day.
Kefir mixed with seeds and fresh parsley. Chop two tablespoons of seeds and parsley, pour a glass of kefir and drink 40 minutes before breakfast. The mixture perfectly removes toxins and saturates the body with vitamins.
External remedies include baths prepared from an infusion of pine branches and red hot pepper pods. Keep your feet in this liquid for up to 30 minutes a day, then put on warm socks.

Calming herbs - motherwort, thyme, valerian - will help cope with alcohol addiction during the treatment of the disease.

Positive dynamics can be achieved only after several months of therapy with complete abstinence from alcohol. Equally important is proper nutrition and physical exercise aimed at strengthening muscles.

Forecast

Without treatment, the symptoms of alcoholic polyneuropathy increase, for the patient this can result in paralysis of the limbs, mental disorders, a lesion of the cerebellum, in which there is functional disorders coordination of movements.

– multiple damage to peripheral nerves in alcoholism. Usually occurs in the later stages of alcoholism. Accompanied by muscle weakness, sensory disturbances and ataxia. Possible increased sweating. Swelling, changes in temperature and coloration of the distal extremities are often observed. In some cases there are mental disorders. It develops gradually, less often acutely. With treatment, symptoms are reduced over several months or years. Vitamin therapy, metabolic therapy and physiotherapy are provided. If you give up alcohol, the prognosis is quite favorable.

ICD-10

G62.1

General information

Alcoholic polyneuropathy is a disease accompanied by simultaneous damage to a large number of peripheral nerves. According to statistics, polyneuropathy, accompanied by neurological symptoms, is detected in 10-30% of patients suffering from alcoholism. When conducting a comprehensive electromyographic study, certain disorders indicating the presence of an asymptomatic form of alcoholic polyneuropathy are detected in the majority of chronic alcoholics.

Men suffer clinical forms polyneuropathy more often in women. In most cases there is chronic or subacute course. Sometimes the disease develops acutely, against the background of binge drinking or hypothermia. The duration of the disease can vary significantly and range from several months to several years. The outcome largely depends on timely treatment and cessation of alcohol consumption. Alcoholic polyneuropathy often causes disability, which can subsequently be removed if treatment results are satisfactory. Treatment of this disease carried out by neurologists in collaboration with specialists in the field of addiction.

Reasons for development

The main reasons for the development of alcoholic polyneuropathy are: the toxic effect of alcohol on the body, lack of B vitamins, nutritional disorders, increased blood sugar and hereditary characteristics of the patient’s metabolism. Pathology, as a rule, occurs in patients with the third, less often – with the second stage of alcoholism. The likelihood of symptoms of polyneuropathy increases when taking low-quality alcohol, denatured alcohol and all kinds of chemical liquids containing ethyl alcohol.

At constant use Alcohol in the patient's body accumulates a toxic intermediate product of ethanol breakdown - acetaldehyde. It has a destructive effect on all organs and tissues, including the axons of nerve cells. The rate of accumulation of acetaldehyde in to a large extent is determined by hereditarily determined metabolic features - the body’s ability to produce acetaldehyde dehydrogenase and alcohol dehydrogenase (enzymes involved in the processing of ethanol).

The situation is aggravated by a deficiency of vitamin B1, which is involved in the transmission nerve impulses, acts as an antioxidant, prevents cell destruction (including cells nerve tissue) and affects the processing of alcohol in the liver. Lack of vitamin B1 is due to a whole range of reasons, including insufficient or unbalanced nutrition associated with decreased appetite, binge drinking, financial difficulties and inattention to one’s health; deterioration in the absorption of vitamin B1 in the intestines; dysfunction of liver cells, etc.

Classification

All disorders develop gradually, pathological changes in the peripheral nervous system arise long before the first ones appear clinical symptoms. Taking into account the severity of these changes, as well as the presence or absence clinical symptoms There are 4 stages of polyneuropathy:

Stage 0– polyneuropathy is absent. Signs of pathology are not detected even during special studies (electromyography, quantitative vegetative and sensory testing).
Stage 1– asymptomatic polyneuropathy. There are no clinical signs, however special studies indicate the presence of pathological changes.
Stage 2– clinically significant polyneuropathy. The disease can be diagnosed based on complaints and objective research, there is no pronounced functional defect.
Stage 3– polyneuropathy with pronounced functional disorders. Working capacity is reduced or lost.

Symptoms of alcoholic polyneuropathy

The first manifestations of alcoholic polyneuropathy are usually paresthesia - sensory disturbances manifested a feeling of lightness numbness, crawling and tingling. Patients complain that they “rested their leg” when sitting for a long time or “rested their arm” while sleeping. On initial stages polyneuropathy, paresthesia, appears only after prolonged exposure to an uncomfortable position, and therefore often does not cause much concern in patients.

Subsequently, the incidence and severity of paresthesia increases. Temperature and pain sensitivity decrease, numbness becomes constant and gradually spreads in the proximal direction. Patients with severe polyneuropathy say that their hands and feet feel as if they are wearing gloves and socks that reduce sensitivity. When walking, a feeling of movement “on a cushion of air” is created. When working with your hands, objects are difficult to perceive by touch. The symptom can progress either abruptly (over about a month) or gradually (over a year or more).

Paresthesia can be combined with progressive muscle weakness, which also spreads in an ascending direction. In some cases, the clinical picture is dominated by muscle weakness, and paresthesia fades into the background. Sensory and muscle disorders in the lower extremities are detected in almost all patients. Upper limbs are involved in the process in approximately 50% of cases. When thick, fast-conducting nerve fibers are damaged, not only temperature and pain, but also vibration sensitivity, as well as muscle-articular sensation, are affected. In severe cases, paralysis occurs.

Diagnostics

At neurological examination in the early stages, an increase in tendon reflexes is detected, in the later stages - a decrease. Skin and pain sensitivity is reduced. Muscle tone is reduced, if there is muscle disorders atrophy develops quickly. Sometimes contractures form in the distal limbs. Damage to the calf muscles is often observed, accompanied by increased pain upon palpation of the muscles and pressure on the area of passage of the nerves innervating this anatomical region. As additional method To confirm the diagnosis of polyneuropathy, electromyography, quantitative autonomic and sensory testing are used.

Treatment of alcoholic polyneuropathy

Treatment includes complete abstinence from drinking alcohol and good nutrition. Patients are prescribed B vitamins in tablets and injections, antioxidants, antihypoxants, agents to improve microcirculation and nerve conduction. For intense pain, analgesics are used, sometimes anticonvulsants and antidepressants. Conduct