Zusammenfassung:
Die Alkoholpolyneuropathie kommt bei ca. 10 % bis 30 % von Alkoholkranken vor. Nach
dem Diabetes mellitus ist chronischer Alkoholismus die zweithäufigste Ursache von
Polyneuropathien. Klinisch handelt es sich um einen symmetrisch-sensiblen bis symmetrisch-paretischen
Manifestationstyp. Nahezu immer findet man anfänglich einen Wadendruckschmerz, auch
stehen anfangs Tiefensensibilitätsstörungen neben ASR-Verlust im Vordergrund. Störungen
des autonomen Nervensystems betreffen sowohl den Parasympathikus wie den Sympathikus.
Morphologisch handelt es sich vornehmlich um eine axonale Degeneration. Als pathogenetischer
Mechanismus ist v. a. eine direkte toxische Einwirkung des Alkohols zu diskutieren.
The Alcoholic Polyneuropathy:
The Alcoholic Polyneuropathy occurs in about 10 - 30 % of alcoholics. It is the second
most frequent type of polyneuropathies after the diabetic form. The clinical pattern
is a symmetric sensory or symmetric motor sensory manifestation type. In almost all
cases there is a pressure pain of the calves. In the beginning the disturbance of
the proprioceptive sensation is predominant. Disturbances of the autonomic nervous
system deal with the sympathetic as well as the parasympathetic nervous system. Morphologically
there is a primary axonal degeneration. A direct toxic influence of the alcohol itself
is discussed as the prevailing pathomechanism.
Literatur
- 1
Schneemann M, Kunze K.
Inhaltsanalyse von 152 Krankengeschichten Alkoholkranker und statistische Beziehungen
der wichtigsten Folgezustände.
Schweiz Arch Neurol Neurochir Psychiatr.
1973;
113
73-86
- 2 Victor M. Polyneuropathy due to nutritional deficiency and alcoholism. In: Dyck
PJ, Thomas PK, Lambert EH, Bunge RP (eds). Peripheral Neuropathy. Philadelphia: Saunders
1984: 1899-1940
- 3
Hillbom M, Wennberg A.
Prognosis of alcoholic peripheral neuropathy.
J Neurol Neurosurg Psychiat.
1984;
47
699-703
- 4
Neundörfer B, Claus D, Burkowski H.
Neurologische Folgeerkrankungen bei chronischem Alkoholismus.
Wien klin Wschr.
1984;
96
576-580
- 5
Neundörfer B.
Polyneuropathien. Standards.
Nervenheilk.
1995;
14
164-173
- 6
Neundörfer B.
Zur Klinik der Polyneuritiden.
Therapiewoche.
1978;
28
4881-4894
- 7
Matthews W B.
Cryptogenetic polyneuritis.
Proc R Soc Med.
1952;
45
667-669
- 8
Prineas J.
Polyneuropathies of undetermined cause.
Acta Neurol Scand.
1970;
46
4-72
- 9 Vallat J M. Communication personnelle, 1991. In: Bouche P, Vallat JM (eds). Neuropathies
Périphériques Paris: Doin 1992: 34
- 10
Aimard G, Trouillas P, Fournier G, Devic M.
Remarques à propos d’une statistique hospitalière de 129 cas de neuropathies périphériques.
Lyon Méd.
1976;
235
295-302
- 11
Pessione F, Gerchstein J L, Rueff B.
Parental history of alcoholism: a risk factor for alcohol-related peripheral neuropathies.
Alcohol & Alcoholism.
1995;
30
740-754
- 12 Mauri M, Pezzica P, Gasterini M. et al .Disturbi da uso di alcool. In: Cassano
GB (ed). Trattato Italiano di Psichiatria Vol 2 Milano: Masson 1994: 1199-1240
- 13 Victor M. Neurologic disorders due to alcoholism and malnutrition. In: Joynt RJ
(ed). Clinical Neurology. Vol 4, Chap 61 Philadelphia: Lippincott 1994: 1-94
- 14
Ammendola A, Gemini D, Iannaccone S, Argenzio F, Ciccone G, Ammendola E, Serio L,
Ugolini G, Bravaccio F.
Gender and peripheral neuropathy in chronic alcolism: A clinical-electroneurographic
study.
Alcohol & Alcoholism.
2000;
35
368-371
- 15
Bischoff A.
Die alkoholische Polyneuropathie. Klinische, ultrastrukturelle und pathogenetische
Aspekte.
Dtsch med Wschr.
1971;
96
317-322
- 16
Neundörfer B.
Ein Beitrag zur Alkoholpolyneuropathie. Klinisches Bild sowie elektromyographische
und elektroneurographische Untersuchungsergebnisse.
Fortschr Neurol Psychiat.
1972;
40
270-286
- 17
Schenck E, Dietz V.
Alkoholische Polyneuropathie. Elektrophysiologische und klinische Befunde bei 85 Patienten.
Arch Psychiat Nervenkr.
1975;
220
150-170
- 18 Victor M. Neurologic disorders due to alcoholism and malnutrition. In: Baker AB,
Baker LH (eds). Clinical Neurology. Vol 2, Chap 22 Philadelphia: Harper and Row 1981:
1-45
- 19 Windebank A J. Polyneuropathy due to nutritional deficiency and alcoholism. In:
Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF (eds). Peripheral Neuropathy. Philadelphia
London Toronto Montreal Sydney Tokyo: Saunders 1993: 1310-1321
- 20
Zimmermann C W, Langohr H D.
Die alkoholische Polyneuropathie.
Internist.
1984;
25
637-641
- 21
Tabaraud F, Vallat J M, Hugon J, Ramiandrisoa H, Dumas M, Signoret J L.
Acute or subacute alcoholic neuropathy mimicking Guillain-Barré syndrome.
J Neurol Sci.
1990;
97
195-205
- 22
Wöhrle J C, Spengos K, Steinke W, Goebel H H, Hennerici M.
Alcohol-related Acute Axonal Polyneuropathy. A Differential Diagnosis of Guillain-Barré
Syndrome.
Arch Neurol.
1998;
55
1329-1334
- 23
Vandenbulcke M, Janssens J.
Acute axonal polyneuropathy in chronic alcoholism and malnutrition.
Acta Neurol Bel.
1999;
99
198-201
- 24
Novak D J, Victor M.
The Vagus and Sympathetic Nerves in Alcoholic Polyneuropathy.
Arch Neurol.
1974;
30
273-284
- 25
Duncan G, Johnson R H, Lambie D G, Whiteside E A.
Evidence of vagal neuropathy in chronic alcoholics.
Lancet.
1980/II;
8203
1053-1057
- 26
Chida K, Takasu T, Mori N, Takunaga K, Komatsu K, Kawamura H.
Sympathetic dysfunction mediating cardiovascular regulation in alcoholic neuropathy.
Function Neurol.
1994;
9
65-73
- 27
Malpas S C, Whiteside E A, Maling T J.
Heartrate variability and cardiac autonomic function in men with chronic alcoholic
dependence.
Br Heart J.
1991;
65
84-88
- 28
Villalta J, Estruch R, Antunez E, Valls J, Urbano-Mårquez A.
Vagal neuropathy in chronic alcoholics: relation to ethanol consumption.
Alcohol & Alcoholism.
1989;
24
421-429
- 29
Weise F, Müller D, Krell D, Kielstein V, Koch R D.
Untersuchungen zur autonomen alkoholischen Polyneuropathie.
Z ges inn Med.
1985;
40
160-162
- 30
Yokoyama A, Takagi T, Ischii H. et al .
Impaired autonomic nervous system in alcoholics assessed by heart rate variation.
Alcohol Clin Exp Res.
1991;
15
761-765
- 31
Appenzeller O, Ogin G.
Myelinated fibres in human paravertebral sympathetic chain: White rami communicantes
in alcoholic and diabetic patients.
J Neurol Neurosurg Psychiat.
1974;
37
1155-1161
- 32
Guo Y P, McLeod J P, Baverstock J.
Pathological changes in the vagus nerve in diabetes and chronic alcoholism.
J Neurol Neurosurg Pschiat.
1987;
50
1449-1453
- 33
Walsh J C, McLeod J G.
Alcoholic neuropathy: an electrophysiological and histological study.
J Neurol Sci.
1970;
10
457-469
- 34
Low P A, Walsh J W, Huang C Y, McLeod J G.
The sympathetic nervous system in alcoholic neuropathy. A clinical and pathological
study.
Brain.
1975;
98
357-364
- 35
Montefort R, Estruch R, Valss-Sole J, Nicolas J, Villalta J, Urbano-Marquez A.
Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related
toxic effect of alcohol.
Arch Neurol.
1995;
52
45-51
- 36
Agelink M W, Malessa R, Weisser U, Lemmer W, Zeit T, Majewski T, Klieser E.
Alcoholism, peripheral neuropathy (PNP) and cardiovascular autonomic neuropathy (CAN).
J Neurol Sci.
1998;
161
135-142
- 37
Miralles R, Espadaler J M, Navarro X, Rubiés-Prat J.
Autonomic Neuropathy in Chronic Alcoholism: Evaluation of Cardiovascular, Pupillary
and Sympathetic Skin Responses.
Europ Neurol.
1995;
35
287-292
- 38
Matikainen E, Juntunen J, Salmi T.
Autonomic dysfunction in long-standing alcoholism.
Alcohol & Alcoholism.
1986;
21
69-73
- 39
Johnson R H, Robinson B J.
Mortality in alcoholism with autonomic neuropathy.
J Neurol Neurosurg Psychiat.
1988;
51
476-480
- 40
Tan E, Johnson R H, Lambie D G, Whiteside E A.
Alcoholic vagal neuropathy: recovery following prolonged abstinence.
J Neurol Neurosurg Psychiat.
1984;
47
1335-1337
- 41
Tan E TH, Johnson R H, Lambie D G, Vijayasenam M E, Whiteside E A.
Erectile impotence in chronic alcoholics.
Alcoholism.
1984;
8
297-301
- 42
Valls-Sole J, Monforte R, Estruch R.
Abnormal sympathetic skin response in alcoholic subjects.
J Neurol Sci.
1991;
102
233-237
- 43
Tugnoli V, Eleopra R, de Grandis D.
Hyperhidrosis and sympathetic skin response in chronic alcoholic patients.
Clin Autonom Res.
1999;
9
17-22
- 44
Ahmed I.
F-wave conduction velocity in alcoholic polyneuropathy.
South Med J.
1980;
73
1320-1321
- 45
Behse F, Buchthal F.
Alcoholic neuropathy: clinical electrophysiological and biopsy findings.
Ann Neurol.
1977;
2
95-110
- 46
Casey E B, leQuesne P M.
Electrophysiological evidence for a distal lesion in alcoholic neuropathy.
J Neurol Neurosurg Psychiat.
1972;
35
624-630
- 47
Dehen H, Willer J C, Cambier J.
Le reflexe H du muscle pédieux: étude chez le sujet normal et au cours des neuropathies
alcooliques latentes.
Rev Neurol.
1976;
132
502
- 48
Lefebvre D'Amour M, Shahani B T, Young R R, Bird K T.
The importance of studying sural nerve conduction and late responses in the evaluation
of alcoholic subjects.
Neurology.
1979;
29
1600-1604
- 49
Walker G, Rethel R, Meyer J G, Neundörfer B, Raute-Kreinsen U, Stegarn B, Buss J,
Bayerl J, Böttinger C.
Untersuchungen zur systemisch toxischen Wirkung des Alkohols.
Med Welt.
1980;
31
978-981
- 50
Thiele B, Stålberg E.
Single fibre EMG findings in polyneuropathies of different aetiology.
J Neurol Neurosurg Psychiat.
1975;
38
881-887
- 51
Hilz M J, Zimmermann P, Claus D, Neundörfer B.
Thermal threshold determination in alcoholic polyneuropathy: an improvement of diagnosis.
Acta Neurol Scand.
1995;
91
389-393
- 52
Hilz M J, Zimmermann P, Rösl G, Scheidler W, Braun J, Stemper B, Neundörfer B.
Vibrameter testing facilitates the diagnosis of uremic and alcoholic polyneuropathy.
Acta Neurol Scand.
1995;
92
486-490
- 53
Hilz M J, Claus D, Neundörfer B, Zimmermann P, Beric A.
Is heat hypoalgesia a useful parameter in quantitative thermal testing of alcoholic
polyneuropathy?.
Muscle Nerve.
1994;
17
1456-1460
- 54
Said G, Landrien P.
Itude quantitative des fibres nerveuses isolées dans les polynévrites alcooliques.
J Neurol Sci.
1978;
35
317-330
- 55
Bilancini S, Lucchi M, Curri S B.
Microangiopathy of Ethylic Polyneuropathy.
Angiology.
1992;
43
933-938
- 56
Strauss M B.
Etiology of „alcoholic” polyneuritis.
Amer J Med Sci.
1935;
189
378-382
- 57
Fennelly J, Frank O, Baker H, Leevy C M.
Peripheral neuropathy of the alcoholic: I. Aetiological role of aneurin and other
B-complex vitamins.
Brit med J.
1964/II;
5420
1290-1292
- 58
Meyer J G, Neundörfer B, Rethel R, Walker G, Bayerl J.
Über die Beziehung zwischen alkoholischer Polyneuropathie und Vitamin B1, B12 und Folsäure.
Nervenarzt.
1981;
52
329-332
- 59
Langohr H D.
Neurologische Komplikationen bei chronischem Alkoholismus.
Med Welt.
1980;
31
171-176
- 60
Claus D, Eggers R, Engelhardt A, Neundörfer B, Warecka K.
Ethanol and polyneuropathy.
Acta Neurol Scand.
1985;
72
312-316
- 61 Krebs H. The effects of alcohol on metabolic processes. In: Richter D (ed). Addiction
and brain damage Baltimore: Univ Park Press 1980: 11-23
- 62
Charness M E, Simon R P, Greenberg D A.
Ethanol and the Nervous System.
New Engl J Med.
1989;
321
442-454
- 63
Manzo L, Locatelli C, Candura S M, Costa L G.
Nutrition and Alcohol Neurotoxicity.
Neuro Toxicol.
1994;
13
555-566
- 64
Martin P R, Adinoff B, Weingartner H, Mukherjee A B, Eckardt M J.
Alcoholic organic brain disease: nosology and pathophysiologic mechanismus.
Prog Neuro-Psychopharm Biol Psychiat.
1986;
10
147-164
- 65
Woelk H, Lehrl S, Bitsch R, Köpcke W.
Benfotiamine in treatment of alcoholic polyneuropathy: An 8-week randomized controlled
study (BAP I Study).
Alcohol & Alcoholism.
1998;
33
631-638
- 66
McLane J A.
Decreased axonal transport in rat nerve following acute and chronic ethanol exposure.
Alcohol.
1987;
4
385-389
- 67
Thome J, Foley P, Gsell W, Davids E, Wodarz N, Wiesbeck G A, Böning J, Riederer P.
Increased concentrations of manganese superoxide dismutase in serum of alcohol-dependent
patients.
Alcohol & Alcoholism.
1997;
32
59-65
- 68
Thome J, Zhang J, Davids E, Foley P, Weijers H -G, Wiesbeck G A, Böning J, Riederer P,
Gerlach M.
Evidence for increased oxidative stress in alcohol-dependent patients provided by
quantification of in vivo salicylate hydroxylation products.
Alcohol Clin Exp Res.
1997;
21
82-85
- 69
Juntunen J, Matikainen E, Nickels J ,. et al .
Alcoholic neuropathy and hepatopathy in mice. An experimental study.
Acta Pathol Microbiol Immunol Scand.
1983;
91
137-144
- 70
Bosch E P, Pelham R W, Rasool C G,. et al .
Animal models of alcoholic neuropathy: morphologic, electrophysiologic, and biochemical
findings.
Muscle & Nerve.
1979;
2
133-144
- 71
Hallett M, Fox J G, Rogers A E, Nicolosi R, Schoene W, Goolsby H A, Landis D MD, Pezeshkpour G.
Controlled studies on the effects of alcohol ingestion on peripheral nerves of Macaque
monkeys.
J Neurol Sci.
1987;
80
65-71
- 72
Spahn T W, Lohse A W, Otto G, Tettenborn B, Hopf H C, Meyer zum Büschenfelde K H.
Remission of severe alcoholic polyneuropathy after liver transplantation.
Z Gastroenterol.
1995;
33
711-714
- 73
Baker H.
Absorption and passage of fat- and water-soluble thiamin derivates into erythrocytes
and cerebrospinal fluid of man.
Amer J Clin Nutr.
1974;
27
676-680
- 74
Davis R E.
Clinical chemistry of thiamine.
Adv Clin Chem.
1983;
23
93-140
- 75
Heinrich H C.
Thiamin- und Folsäuremangel bei chronischem Alkoholismus, Eisen- und Cobalaminmangel
bei veganischer Ernährung.
Ernährungs-Umschau.
1990;
37
594-607
1 Herrn Prof. Dr. Otto Hallen zum 80. Geburtstag gewidmet
Prof. Dr. Bernhard Neundörfer
Neurologische Klinik mit Poliklinik
der Universität Erlangen Nürnberg
Schwabachanlage 6
91054 Erlangen
