Printer Friendly

Study on alcohol and its neurological complications.

INTRODUCTION

Alcoholism is characterised by alcohol tolerance, signs and symptoms of withdrawal and continued use in spite of insidious physical or psychological consequences. Recent diagnostic criteria define Alcohol Use Disorder by the presence of at least 2 out of the given conditions for more than a yeartolerance, signs and symptoms of alcohol withdrawal, drinking in excessive amount, a strong desire to use alcohol, unsuccessful efforts to reduce drinking, spending more time in alcohol and alcohol related activity, affecting one's personal work and social lifestyle due to alcohol, continuous alcohol use despite persistent social, interpersonal problems, alcohol use in spite of persistent recurrent physical and psychological consequences (DSM-5, 2013). Chronic alcohol abuse causes several distinct diseases affecting many organs including the liver, lung, stomach and the brain. However, the alcohol affecting the brain is the most significant factor for maintaining this alcohol abuse. These effects include emotional and behavioural changes as well as defective judgement, learning disability and memory dysfunction. Studies have shown that radio-imaging studies have documented presence of damage in the brain of alcoholics like shrinkage of the brain and atrophy of the nerve cells. At the basic cellular level, alcohol affects the functioning of the brain by affecting the gamma-aminobutyric acid, glutamate and other neurotransmitters. (1) The neurological complications of alcoholism includes both the peripheral and the central nervous system.

They are the alcohol withdrawal syndrome which includes alcohol withdrawal seizures, delirium tremens, alcohol hallucinosis.

The other neurological complications are the alcoholic peripheral neuropathy, alcoholic myopathy, Wernicke encephalopathy, combination of Wernicke encephalopathy with Korsakoff's psychosis. (1) Besides these complications less common complications have been identified which includes Marchiafava-Bignami Syndrome, subacute encephalopathy with seizure activity (SESA Syndrome), alcohol cerebellar degeneration which are usually diagnosed by their characteristic MRI and EEG findings. (2)

Incidences and Prevalence in India

According to the WHO 2014, global status report on alcohol and health, 38.3 % of the total world population consumes alcohol and 30% of the total population in India. (3) The prevalence of alcohol dependence is 12.5% and the prevalence of alcohol abuse is 17.8% in a lifetime. (3) The per capita consumption of alcohol globally is 6.6 litres, in India it is 2.2 litres. Around 200 different health conditions covered by the ICD-10 is associated with alcohol consumption. Out of which 3.3 million deaths are attributed to alcohol globally. (3) These statistical data encourages and contributes towards the importance of further researches in alcoholism and its underlying mechanism.

AIMS AND OBJECTIVES

1. To study the prevalence of various neurological related complications in alcoholism.

2. To study the correlation of duration and quantity of alcohol intake leading to neurological complications.

MATERIALS AND METHODS

The present study was undertaken under the Department of General Medicine, Govt. Stanley Hospital, Chennai. The study consists of 150 patients with history of alcohol intake satisfying the inclusion and exclusion criteria, presenting in medical OPD/wards/ICU, after proper consent were subjected to questionnaires, complete physical examination and relevant laboratory investigations as per proforma. A prospective observational study design was chosen and descriptive statistics was done for all data and suitable statistical tests of comparison for a period of 6 months.

Inclusion Criteria

Patients with history of alcoholism.

Exclusion Criteria

1. Patients with Chronic liver disease/Hepatic Encephalopathy.

2. Patients with known Seizure disorder.

3. Patients with Diabetes Mellitus.

4. Patients with Psychiatric illness.

5. Patients with Congenital disease.

6. Patients with Cerebrovascular accidents.

7. Patients with acute CNS infections.

Study Duration: Jan. 2015 to Sept. 2015

Study Design: Prospective Observational Study.

Sample Size: 150

Data Collection

This study is an observational prospective study, wherein 150 alcoholic patients satisfying inclusion and exclusion criteria were subjected to answer a set of questionnaires, complete physical examination and relevant laboratory investigations as per proforma, exclusively designed for the study. Prior permission from Institutional Ethics Committee was taken, written/informed consent from every subject was taken.

Statistics

Descriptive statistics was done for all data and were reported in terms of whole observed values and percentages. Suitable statistical tests of comparison were done. Categorical variables were analysed with the Chi-Square Test. Statistical significance was taken as P<0.05. The data was analysed using SPSS version 16 and Microsoft Excel 2007.

Alcoholism Definition

National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine defines alcoholism as a primary, chronic disease characterized by impaired control over thinking, pre-occupation with the drug alcohol, use of alcohol despite adverse consequences and distortions in thinking. DSM-IV defines alcoholism as maladaptive alcohol use with clinically significant impairment.

RESULTS

Neurological Complications in Alcoholics

In our study patients, alcohol withdrawal seizures (38%) was the most common neurological complication followed by acute hallucinosis (20%). Alcoholic myopathy (2%) and WernickeKorsakoff syndrome (8%) were the least common neurological complications seen.

Age Distribution

Study showed that in 26-35 yrs., acute hallucinosis (35%) was more prevalent. In 36-55 yrs., alcohol withdrawal seizures (46%) was more prevalent, whereas in 56-65 yrs. alcohol polyneuropathy (21%) was more prevalent. The study also concluded that the incidence of alcohol hallucinosis was significantly and consistently higher in younger age group patients and the incidence of alcoholic polyneuropathy, Wernicke's encephalopathy, Wernicke's-Korsakoff syndrome were significantly and consistently higher in very older age group patients.

Gender Distribution

The alcohol intake and its associated neurological complications were found to be more prevalent among the males (90%) as compared to females and transgender. There was a contribution of 5% of female alcoholics and 4% of transgender alcoholics in the study group.

Brand of Alcohol

It was observed that brandy (29%) was the most common brand of alcohol used among the study group followed by whiskey (22%). Of the brands, wine (2%) and country liquor were the least commonly used.

Duration of Alcohol Intake

It was found in the study that alcohol withdrawal seizure was the most common neurological complication seen except in the group with history of alcohol intake for a duration 0-5 years, alcohol hallucinosis was more prevalent.

The study also concluded that incidence of alcohol hallucinosis was significantly and consistently higher in patients with lesser duration of alcohol intake, whereas the incidence of alcoholic polyneuropathy and WernickeKorsakoff encephalopathy was significantly and consistently higher in patients with longer duration of alcohol intake.

Quantity of Alcohol Intake

The participants taking alcohol of around 840 gm/week had alcohol hallucinosis more common as a neurological complication, whereas the prevalence of alcohol hallucinosis and alcohol withdrawal seizure was equally seen in participants with alcohol intake of around 770 gm/week. For the rest of the group alcohol withdrawal seizure was the most common neurological complication. The study also concluded that the incidence of alcohol hallucinosis, Wernicke's encephalopathy and Wernicke-Korsakoff syndrome was significantly and consistently higher in patients with higher quantity of alcohol intake. The incidence of alcoholic polyneuropathy was significantly and consistently higher in patients with lower quantity of alcohol intake.

Age of Onset of Alcohol Consumption

In our study, it was found that the maximum age of onset of alcohol consumption was between 26-30 years of age.

DISCUSSION

Excessive indulgence of an individual in alcohol causes many problems and chaos at the individual level as well as at the society level. The chronic effects of alcohol abuse include neurological complications through both direct and indirect effects on the central and peripheral nervous system. These complications include alcohol withdrawal syndrome in the form of delirium tremens which is characterized by a state of intense acute withdrawal state in the form of mental confusion, diaphoresis, agitation, fluctuating levels of consciousness, visual and auditory hallucinations associated with tremors and autonomic activity!4) Alcohol withdrawal seizures occur within 48 hours of alcohol cessation and occur either as a single generalized tonic-clonic seizure or a brief episode of multiple seizures usually with a normal EEG record!5) In alcohol hallucinosis the patients have transient visual, auditory or tactile hallucination, but are otherwise clear. Principally Wernicke's encephalopathy is a nutrition deficiency disorder due to brain damage caused by lack of thiamine, most frequently seen in chronic alcoholic patients characterised by a triad of mental confusion, ataxia and ophthalmoplegia. Wernicke-Korsakoff Syndrome includes symptoms of Wernicke's encephalopathy along with global amnesia, which includes both retrograde and anterograde amnesia and confabulation. (6) Here, MRI findings may show hyperintense T2 lesions in mammillary bodies, medial thalami, tectal plate, periaqueductal area. Alcohol polyneuropathy is characterised by axonal degeneration and demyelination. Symptoms include paraesthesias, pain and weakness, reduced pain and temperature sensations confirmed by nerve conduction study. In alcohol myopathy, the main complaints include muscle pain, severe cramps in the muscles, weakness of limbs, mostly the proximal muscles and associated swelling of muscles and tenderness. Chronic alcoholic myopathy is characterized by a gradual long-term involvement of the muscles, which are usually painless and involves the weakness of the proximal muscles with associated muscle atrophy.

CONCLUSION

Not all alcoholics are alike. The degree of impairment differs from individual to individual and the aetiology of a particular disease has different origins for different people. With the known existing harmful nature of alcoholism in the society, its complications have been already recognised clinically for years, hence the current recent advances are emphasizing more in understanding the biochemical targets of ethanol and the pathophysiology of the complications. In current scenario, it is still a subject of active research as to what characteristic features makes certain group of alcoholics more vulnerable to brain damage. This study contributes to daily practice when encountering patients with chronic alcohol abuse to identify and differentiate the neurological complications of chronic alcoholism and at the same time understand its pathophysiology so that these treatments can be tailored to individual patients. Also to encourage further researches on advanced technology, to design newer therapies and medicines for diagnosis and to ameliorate alcoholism and alcohol related neurological disorder.

STATISTICS
Table 1: The Percentage of Neurological Complications in Alcoholics

Neurological Complications in Alcoholics    Number    Percentage

Alcohol Withdrawal Seizures                   57         38.00
Delirium Tremens                              28         18.67
Alcohol Hallucinosis                          30         20.00
Alcoholic Polyneuropathy                      14         9.33
Alcoholic Myopathy                             4         2.67
Wernicke Encephalopathy                        9         6.00
Wernicke-Korsakoff Encephalopathy              8         5.33
Total                                         150         100

Table 2: Age Wise Distribution of the Various Neurological
Complications in Alcoholics

Neurological Complications In    26-35        %       36-45       %
Alcoholics-Age Distribution       years               years

Alcohol Withdrawal Seizures        12       28.57      30       46.88
Delirium Tremens                   11       26.19      14       21.88
Alcohol Hallucinosis               15       35.71      13       20.31
Alcoholic Polyneuropathy            2       4.76        3       4.69
Alcoholic Myopathy                  2       4.76        2       3.13
Wernicke Encephalopathy             0       0.00        1       1.56
Wernicke-Korsakoff                  0       0.00        1       1.56
  Encephalopathy
Total                              42        100       64        100

Neurological Complications In     46-55       %       56-65       %
Alcoholics-Age Distribution       years               years

Alcohol Withdrawal Seizures        10       33.33       5       35.71
Delirium Tremens                    3       10.00       0       0.00
Alcohol Hallucinosis                0       0.00        2       14.29
Alcoholic Polyneuropathy            6       20.00       3       21.43
Alcoholic Myopathy                  0       0.00        0       0.00
Wernicke Encephalopathy             6       20.00       2       14.29
Wernicke-Korsakoff                  5       16.67       2       14.29
  Encephalopathy
Total                              30        100       14        100

Neurological Complications In      P value Chi
Alcoholics-Age Distribution       Squared Test

Alcohol Withdrawal Seizures           0.258
Delirium Tremens                      0.082
Alcohol Hallucinosis                  0.003
Alcoholic Polyneuropathy              0.028
Alcoholic Myopathy                    0.579
Wernicke Encephalopathy               0.001
Wernicke-Korsakoff                    0.003
  Encephalopathy
Total

Table 3: The Distribution and the Percentage of Neurological
Complications in Alcoholics-Gender Wise

Neurological Complications in     Male      %      Female     %
Alcoholics-Gender Distribution

Alcohol Withdrawal Seizures        53     38.97      3      37.50
Delirium Tremens                   28     20.59      0       0.00
Alcohol Hallucinosis               27     19.85      0       0.00
Alcoholic Polyneuropathy           12      8.82      1      12.50
Alcoholic Myopathy                  4      2.94      0       0.00
Wernicke Encephalopathy             6      4.41      2      25.00
Wernicke-Korsakoff                  6      4.41      2      25.00
  Encephalopathy
Total                              136     100       8       100

Neurological Complications in     Transgender     %      P value Chi
Alcoholics-Gender Distribution                          Squared Test

Alcohol Withdrawal Seizures            1        16.67       0.545
Delirium Tremens                       0         0.00       0.17
Alcohol Hallucinosis                   3        50.00       0.068
Alcoholic Polyneuropathy               1        16.67       0.772
Alcoholic Myopathy                     0         0.00       0.804
Wernicke Encephalopathy                1        16.67       0.033
Wernicke-Korsakoff                     0         0.00       0.037
  Encephalopathy
Total                                  6         100

Table 4: The Percentage of Brand of Alcohol Used in Alcoholics

Brand of Alcohol Used    Number    Percentage

Beer                       28         18.67
Wine                        3         2.00
Whiskey                    34         22.67
Brandy                     44         29.33
Rum                        25         16.67
Vodka                       9         6.00
Country Liquor              7         0.00
Total                      150         95

Table 5: The Relation between the Duration of Intake of Alcohol and
the Development of Neurological Complications

Neurological Complications in     0-5        %       6-10       %
Alcoholics Vs Duration of        years              years
Intake

Alcohol Withdrawal Seizures        13      33.33      15      30.61
Delirium Tremens                   8       20.51      13      26.53
Alcohol Hallucinosis               15      38.46      11      22.45
Alcoholic Polyneuropathy           0       0.00       4       8.16
Alcoholic Myopathy                 1       2.56       3       6.12
Wernicke Encephalopathy            2       5.13       1       2.04
Wernicke-Korsakoff                 0       0.00       2       4.08
  Encephalopathy
Total                              39       100       49       100

Neurological Complications in    11-15       %      16-20       %
Alcoholics Vs Duration of         years             years
Intake

Alcohol Withdrawal Seizures        19      52.78      6       30.00
Delirium Tremens                   7       19.44      0       0.00
Alcohol Hallucinosis               1       2.78       3       15.00
Alcoholic Polyneuropathy           4       11.11      5       25.00
Alcoholic Myopathy                 0       0.00       0       0.00
Wernicke Encephalopathy            4       11.11      2       10.00
Wernicke-Korsakoff                 1       2.78       4       20.00
  Encephalopathy
Total                              36       100       20       100

Neurological Complications in    21-25       %      P value Chi
Alcoholics Vs Duration of        years              Squared Test
Intake

Alcohol Withdrawal Seizures        4       66.67       0.103
Delirium Tremens                   0       0.00        0.087
Alcohol Hallucinosis               0       0.00        0.003
Alcoholic Polyneuropathy           1       16.67       0.034
Alcoholic Myopathy                 0       0.00        0.412
Wernicke Encephalopathy            0       0.00        0.402
Wernicke-Korsakoff                 1       16.67       0.012
  Encephalopathy
Total                              6        100

Table 6: The Relation of the Quantity of Alcohol Intake with the
Neurological Complications

Neurological Complications in      490       %        560       %
Alcoholics Vs Quantity of        g/week             g/week
Intake

Alcohol Withdrawal Seizures         7      43.75       8      33.33
Delirium Tremens                    2      12.50       2       8.33
Alcohol Hallucinosis                4      25.00       3      12.50
Alcoholic Polyneuropathy            0       0.00       5      20.83
Alcoholic Myopathy                  1       6.25       0       0.00
Wernicke Encephalopathy             1       6.25       4      16.67
Wernicke-Korsakoff                  1       6.25       2       8.33
Encephalopathy
Total                              16       100       24       100

Neurological Complications in      630       %        700       %
Alcoholics Vs Quantity of        g/week             g/week
Intake

Alcohol Withdrawal Seizures        16      39.02      15      44.12
Delirium Tremens                    7      17.07      10      29.41
Alcohol Hallucinosis                5      12.20       5      14.71
Alcoholic Polyneuropathy            4       9.76       3       8.82
Alcoholic Myopathy                  2       4.88       1       2.94
Wernicke Encephalopathy             4       9.76       0       0.00
Wernicke-Korsakoff                  3       7.32       0       0.00
Encephalopathy
Total                              41       100       34       100

Table 7: The Relation of the Quantity of Alcohol Intake with the
Neurological Complications

Neurological Complications in      770       %        840       %
Alcoholics Vs Quantity of        g/week             g/week
Intake

Alcohol Withdrawal Seizures         6      33.33       5      29.41
Delirium Tremens                    5      27.78       2      11.76
Alcohol Hallucinosis                6      33.33       7      41.18
Alcoholic Polyneuropathy            1       5.56       1       5.88
Alcoholic Myopathy                  0       0.00       0       0.00
Wernicke Encephalopathy             0       0.00       0       0.00
Wernicke-Korsakoff                  0       0.00       2      11.76
  Encephalopathy
Total                              18       100       17       100

Neurological Complications in      910       %       P value Chi
Alcoholics Vs Quantity of        g/week             Squared Test
Intake

Alcohol Withdrawal Seizures         4      44.44        0.302
Delirium Tremens                    0       0.00        0.113
Alcohol Hallucinosis                3      33.33        0.025
Alcoholic Polyneuropathy            0       0.00        0.017
Alcoholic Myopathy                  1      11.11        0.598
Wernicke Encephalopathy             1      11.11        0.045
Wernicke-Korsakoff                  0       0.00        0.017
  Encephalopathy
Total                               9       100

Table 8: Distribution of the Age of Onset of Alcohol Consumption

Age of Onset of Alcohol Consumption    No.      %

< 20 years                              1      0.67
21-25 years                             46    30.67
26-30 years                             83    55.33
31-40 years                             19    12.67
41-50 years                             1      0.67
Total                                  150     100


REFERENCES

(1.) In: Hunt WA, Nixon SJ, eds. Alcohol-induced brain damage. National institute on alcohol abuse and alcoholism research monograph no. 22.NIH Pub. No 933549. Bethseda, MD: the Institute 1993:121-156.

(2.) Evert DL, Berman OM. Alcohol-related cognitive impairments: an overview of how alcoholism may affect the workings of the brain. Alcohol Health & Research World 1995;19(2):89-96

(3.) Global status report on alcohol and heath. World Health Organisation 2014.

(4.) Alcohol and alcoholism. In: Ropper AH, Samuels MA, Klein J. Adams & Victor's principles of neurology. Chapter 42, 10th edn. McGraw Hill Professional 2014:pgs. 1584.

(5.) Alcoholism, alcohol withdrawal syndrome. Kasper DJ, Jameson L, Hauser S. Harrisons principle of internal medicine. Vol. 1 & Vol. 2. 19th edn. McGraw-Hill Education 2015:pgs. 3000.

(6.) Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff Syndrome. 2nd edn. Philadelphia: Davis 1989.

Financial or Other, Competing Interest: None.

Submission 01-06-2016, Peer Review 27-06-2016, Acceptance 02-07-2016, Published 07-07-2016.

Corresponding Author: Dr. Akumnaro Jamir, Ladies PG Hostel, Room No. 108, Stanley Medical College, Chennai-600001.

E-mail: kumti.jamir@yahoo.com

DOI: 10.14260/jemds/2016/843

Akumnaro Jamir [1], A. Ramalingam [2], G. Vasumathi [3], S. M. Sujatha [4]

[1] Post Graduate, Department of General Medicine, Stanley Medical College, Chennai.

[2] Senior Assistant Professor, Department of General Medicine, Stanley Medical College, Chennai.

[3] Professor, Department of General Medicine, Stanley Medical College, Chennai.

[4] Senior Assistant Professor, Department of General Medicine, Stanley Medical College, Chennai.
COPYRIGHT 2016 Akshantala Enterprises Private Limited
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2016 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Jamir, Akumnaro; Ramalingam, A.; Vasumathi, G.; Sujatha, S.M.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Jul 7, 2016
Words:2913
Previous Article:Serum neopterin: a new novel biomarker in acute myocardial infarction.
Next Article:All ceramic veneers: a case report.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters