Alcoholic polyneuropathy. Clinical forms and pathogenetically based approaches to therapy

Abstract

The number of cases of alcoholism in Russia is gradually decreasing, but still significantly affects the overall health indicators of the population. One of its frequent complications is alcoholic polyneuropathy. The article deals with the pathogenetic mechanisms of the occurrence and development of the disease, its forms, classification, and clinical picture. The damage to the nervous system in patients with alcoholism depends on the frequency of alcohol consumption, the dose, the type of drinks that were consumed, malnutrition, genetic predisposition and individual characteristics that determine the level of alcohol dehydrogenase and aldehyde dehydrogenase. In the clinical picture, a toxic form of alcoholic polyneuropathy is currently distinguished, associated with the direct effect of toxic alcohol metabolites on somatic and autonomic nerve fibers, thiamine deficiency, resulting from a deficiency of B vitamins, and mixed forms. According to the rate of development of clinical manifestations, there are acute forms of alcoholic polyneuropathy (thiamine deficiency) and chronic forms (toxic). The article discusses the possibilities of diagnostics using modern instrumental and laboratory methods of research, primarily electroneuromyography. With the help of this method of investigation, in alcoholic polyneuropathy, signs of axonal damage are most often detected, and in the thiamine-deficient form, it is possible to determine signs of secondary demyelination. The authors emphasize the importance of differential diagnosis with other pathologies. The article highlights the current understanding of the main therapeutic strategies, treatment options for patients with alcoholic polyneuropathy. Therapy of patients suffering from alcoholic polyneuropathy includes refusal of alcohol abuse, normalization of nutrition, medication. For drug therapy, B vitamins and antioxidants are used. The drug with a recognized antioxidant effect is alpha-lipoic acid. A clinical case was analyzed on the basis of our own clinical observation of a mixed form of alcoholic polyneuropathy.