Are there other neurological effects of alcoholism?

Numerous obscure neurological conditions, such as Marchiafava-Bignami Syndrome, which attacks wine drinkers of Italian heritage, appear to affect individuals from certain ethnic backgrounds. Very specific areas of the brain are affected, causing confusion, difficulty speaking (dysphasia), seizures, and dementia. Alcohol can more commonly impact on numerous other neurological systems. Alcohol has a predilection for the cerebellar system of the brain, which is critical in coordinating voluntary movements. This occurs with acute intoxication, thus leading to the staggering gait. It can also lead over time to chronic degeneration of the cerebellar system, causing the gait disturbance even when the individual is sober. This occurs in about 1% of chronic alcoholics. Central pontine myelinolysis, which was discussed in Question 61, results from rapid correction of low sodium, or hyponatremia, and can cause pseudobulbar palsy, which consists of an overemotional state known as pathological laughing and crying, speech difficulties, facial paralysis, quadriplegia, confusion, and coma, if one survives.

Pseudobulbar palsy condition caused by damage to the cranial nerve pathways that can lead to unprovoked outbursts of laughing or crying along with other neurological deficits.

Finally, however, the most common neurological condition is peripheral neuropathy. This occurs in anywhere from 5% to 15% of alcoholics. Chronic alcohol intake can destroy peripheral nerves, particularly the smaller nerves in the hands, feet, and lower legs. The experience is similar to those who suffer from diabetic neuropathy. There is a "stocking-glove" distribution of weakness, numbness, and burning of the hands and feet. One can feel burning pain in the soles of the feet, particularly when walking. Later stages can lead to a foot or wrist drop with muscle wasting. This condition has the potential of traveling up the limb, although rarely does it cause complete paralysis of the affected limb.

What are DTs?

Probably the most well-known, although rarest (affecting only about 5% of alcoholics), but a treatable event can result from daily heavy alcohol use followed by abrupt cessation. Delirium Tremens is an acute confusional state that affects a variety of cognitive processes. These include a waxing and waning of consciousness, disorientation to place and time, attention and concentration impairment, supersensitivity to extraneous stimuli, visual and auditory hallucinations, and paranoid delusions. Tremens is another word for tremors or shakes. The individual suffering from this condition also demonstrates severe tremors as well as high blood pressure and a rapid pulse. This is a medical emergency with upward of a 15% risk of mortality if untreated. Symptoms may begin a few hours after the last drink and peak around 48 to 72 hours later.

Peripheral neuropathy refers to degenerating of the nerves outside of the central nervous system, including the cranial nerves but not the optic or spinal nerves or the autonomic nervous system.

Delirium Tremens (DTs) an acute withdrawl syndrome from alcohol.

As mentioned in Question 6, two primary brain chemicals are involved in the development of this condition: GABA and glutamate.

Downregulation the process by which a call decreases the number of receptors to a given hormone or neurotransmitter to decrease its sensitivity to this molecule.

Upregulation the process by which a cell increases the number of receptors to a given hormone or neurotransmitter to improve its sensitivity to this molecule.

As mentioned in Question 6, two primary brain chemicals are involved in the development of this condition: GABA and glutamate. With chronic use of alcohol, the GABA system attempts to compensate for its increased use by making itself less accessible to alcohol in what is know as downregulation. Over time, in order for the GABA to function correctly, it will need alcohol regularly or risk shutting down altogether. Without GABA, an excited state emerges. This is compounded by the glutamate system, which is the brain's major excitatory neurotransmitter. As alcohol chronically pushes GABA downward, glutamate also tries to compensate by increasing its activity in what is known as upregulation. When alcohol is suddenly withdrawn, the combination of GABA being shut down and glutamate running amok leads to the brain being in an extremely hyperexcitable state. In terms of motor systems, tremors result along with tachycardia or a rapid heart rate and hypertension or high blood pressure. In terms of sensory systems, overstimulation occurs without the ability to process and make sense of the overwhelming amount of information from the environment bombarding it. Thus, the individual becomes disoriented and demonstrates hallucinations, insomnia, irritability, and paranoia. Benzodiazepines are the treatment of choice, as described in Question 56.

Susan's comment:

Nothing in the entire experience has "brought me to my knees" like psychosis and DTs. Even seizures, although horrific to witness, dont last very long. All of the other experiences seem to pale in comparison to watching your offspring in wrist and ankle restraints. It is like watching a nightmare unfold, with your "baby" as the main character. The dull look in his eyes and the mumbling about nonsensical things are shattering events for a mother. I have been able to maintain my composure through everything else but that. I make myself very scarce at those times and limit my visits to peeking in on him and talking to the nurses so that he doesn't hear my voice. I always drive home in tears.

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