Alcohol-related peripheral neuropathy: Clinico-neurophysiological characteristics and diagnostic utility of the neuropathy symptoms score and the neuropathy impairment score

• Published in: Alcohol (Fayetteville, N.Y.) Vol. 117; pp. 65 - 71
• Main Authors: Papantoniou, Michail, Rentzos, Michail, Zampelis, Thomas, Tzavellas, Elias, Paparrigopoulos, Thomas, Kokotis, Panagiotis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024; Elsevier Limited
• Subjects: Action potential; Adult; Age groups; Alcohol; Alcohol abuse; Alcohol use; Alcoholic Neuropathy - diagnosis; Alcoholic Neuropathy - physiopathology; Alcoholism - complications; Alcoholism - diagnosis; Alcoholism - physiopathology; Diabetes; Diabetic neuropathy; Drug abuse; Epidemiology; Female; Fibers; Guillain-Barre syndrome; Humans; Laboratories; large fiber; Male; Medical diagnosis; Middle Aged; Nerve conduction; Nervous system; Neural Conduction - physiology; neuropathy scales; Neurotoxicity; Orthostatic hypotension; Peripheral nerves; Peripheral Nervous System Diseases - diagnosis; Peripheral Nervous System Diseases - physiopathology; Peripheral neuropathy; Prospective Studies; Psychiatric/Mental Health; Sensory neurons; Severity of Illness Index; Skin tests; small fiber; Surveys and Questionnaires; Sympathetic nervous system; NCV; TT; CMAP; large fiber; Alcohol; TAU; small fiber; HT; SNAP; peripheral neuropathy; NSS; CT; QST; SSR; LFN; NIS; SFN; neuropathy scales; NCS; large fiber neuropathy; neuropathy symptoms score; cold threshold; sensory nerve action potential; thermal threshold; quantitative sensory testing; sympathetic skin response; total alcohol units; nerve conduction velocity; compound muscle action potential; small fiber neuropathy; neuropathy impairment score; heat threshold; nerve conduction studies
• ISSN: 0741-8329; 1873-6823; 1873-6823
• DOI: 10.1016/j.alcohol.2024.04.001

Alcohol overconsumption is well known to cause damage to the peripheral nervous system, affecting both small and large nerve fibers. The aim of this descriptive study was to investigate peripheral nerve damage, and to correlate clinical, epidemiological and neurophysiological findings, in patients diagnosed with Alcohol Use Disorder (AUD). Ninety alcohol-dependent subjects on inpatient basis were enrolled in this prospective study over a 3-year period. Every subject was assessed by the Neuropathy Symptoms Score (NSS) questionnaire and the Neuropathy Impairment Score (NIS) clinical examination grading scale, followed by Nerve Conduction Studies, Quantitative Sensory Testing and Sympathetic Skin Response (SSR) testing. Peripheral neuropathy was diagnosed in 54 subjects (60%), by abnormal neurophysiological tests and presence of clinical signs or symptoms. Among them, pure large fiber neuropathy (LFN) was found in 18 subjects, pure small fiber neuropathy (SFN) in 12 subjects, and both large and small fiber neuropathy was diagnosed in 24 subjects. Using linear regression, we found that higher NSS and NIS scores correlated with lower amplitudes of the sural sensory nerve action potential and of the SSR. We also found a significant longer duration of alcohol abuse in subjects with neuropathy, using Student's t-test (p = 0.024). Additionally, applying NIS abnormal cut-off score ≥4, using ROC analysis, we predicted the majority of subjects with LFN, confirming 95.23% sensitivity and 93.75% specificity. Our study confirmed that peripheral neuropathy involving large and small nerve fibers, with a symmetrical length-dependent pattern, is common between patients with AUD and related to the duration of the disorder. We suggest that NSS and NIS scales could be used for the assessment of neuropathy in clinical practice, when the essential neurophysiological testing is not available. •Peripheral neuropathy with feet affected before hands is common in patients with alcohol use disorder.•Alcohol-related peripheral neuropathy correlates with the duration of the abuse.•Neurophysiological testing is essential for the diagnosis of alcohol-related peripheral neuropathy.•Clinical neuropathy scales could be useful for assessing alcohol-related peripheral neuropathy.•Proposed cut-off scores are ≥4 for Neuropathy Impairment Score and ≥1 for Neuropathy Symptoms Score.