Preventing Wernicke's encephalopathy in anorexia nervosa: A systematic review

Abstract

Anorexia nervosa (AN) is a common eating disorder that affects 2.9 million people worldwide. Not eating a balanced diet or fasting can cause neurological complications after severe vitamin B1 malnourishment, although the precise signs and symptoms of Wernicke's encephalopathy (WE) are not clear. Our aim was to review the signs and symptoms of WE in patients with AN. We searched MEDLINE, EMBASE, Scopus, and PiCarta on all case descriptions of WE following AN. All case descriptions of WE in AN, irrespective of language, were included. Twelve WE cases were reviewed, suggesting that WE following AN is still a relatively rare neuropsychiatric disorder. WE is characterized by a triad of: mental status change, ocular signs, and ataxia. In alcoholism, this triad is present in 16% of cases, but eight out of 12 AN cases presented themselves with a full triad of symptomatology. Importantly, patients often had a more complex triad than has been previously described, involving vertigo, diplopia, and the consequences of refeeding syndrome. The development of a full triad and additional symptomatology suggests a late recognition of signs and symptoms of WE in AN. A complicating factor is the overlap between symptoms of thiamine deficiency and the symptoms of WE. Specifically, patients who show rapid weight loss are vulnerable for the development of WE. Eating disorders, such as AN, can lead to WE. Prophylactic thiamine checks and treatment in patients with AN are relevant, and in case of suspicion of WE, adequate parenteral thiamine supplementation is necessary.

Subtle object location perception deficits in Korsakoff’s syndrome

“…In modern society, KS is often caused by severe alcoholism and self-neglect leading to thiamine depletion (Kopelman, Thomson, Guerrini, & Marshall, 2009). Other causes of thiamine deficiency can lead to KS, such as extreme vomiting after obesity surgery, anorexia nervosa, and multiple forms of cancer (Isenberg-Grzeda, Rahane, DeRossa, Ellis, & Nicolson, 2016;Oudman, Wijnia, Oey, van Dam, & Postma, 2018b;Oudman, Wijnia, van Dam, Biter, & Postma, 2018a). KS is characterized by severe cognitive problems, such as explicit memory deficiencies.…”

An audit of the changes in thiamine levels during higher caloric nutritional rehabilitation of adolescent patients hospitalised with a restrictive eating disorder

“…The RDI for thiamine for patients admitted to the adolescent ward ranges from 1.1 mg/day -1.2 mg/day, depending on gender and age [29], and the multivitamin alone provided patients with 10 mg of thiamine daily (approximately 10 times the RDI). Comparison of these findings to other studies is difficult because the amount of thiamine consumed from oral intake and enteral feeds is not being routinely reported [18,19].…”

“…This practice is based on foundation knowledge of the role of thiamine as an essential cofactor in carbohydrate metabolism, an essential pathway during refeeding [2], and previous research demonstrating thiamine supplementation prior to nutritional rehabilitation may prevent TD and its associated neuropsychiatric conditions WE and WKS [16,17]. A study of 37 patients with AN reported a 38% prevalence of TD [18], and a systematic review by Oudman E et al (2018) identified 12 cases of TD causing WE in patients with AN ranging from BMI 12.2 kg/m 2 to 17.4 kg/m 2 , including some patients with a history of alcohol and substance abuse [19].…”

Wernicke's encephalopathy due to malnutrition and parenteral nutrition in a patient with cerebral infarction

“…Previous studies have shown that rapid weight loss and malnutrition can result in WE, and the occurrence of WE is directly linked to rapid weight loss. [ 11 , 12 ]…”