酒釘依存 患者에서 末梢神經炎의 電氣生理學的 硏究

An Electrophysiological Study on the Peripheral Neuropathies in Alcoholics

The alcoholic neuropathies developed in approximately 34% of chronic alcoholics. Direct neurotoxic effect of alcohol, vitamin deficiencies and nutritional deficiencies were suggested to be the major causes of alcoholic neuropathies. The aims of this study were to identify the prevalence of subclinical peripheral neuropathies in alcohol dependence, and to speculate on the underlying mechanism of alcoholic neuropathies. The nerve conduction velocity (NCV) and electromyography (EMG) were tested for the male alcoholics(N=47) and normal controls(N=17), and the variables which might affect the test result of NCV and EMG were discussed. 1) While 8(17.0%) out of 47 alcoholics clinically had neuropathies, the NCV and EMG detected signs of peripheral neuropathies in 34(72.3%) alcoholics. 2) On the motor NCV in alcoholics, the amplitude of peroneal nerve was significantly lowered(p〈0.01). The conduction velocities were significantly reduced in the median(p<0. 005)，ulnar and peroneal(p〈0.05 respectively) nerves. There was no significant differences in the distal latency comparing with control group. 3) On the sensory NCV in alcoholics, the amplitude was significantly lowered in ulnar(p〈0. 0005) and sural(p〈0.05) nerves. The conduction velocities were significantly reduced in median nerve(p <^0.05). The distal latencies were significantly delayed in ulnar nerve(p〈0.005). 4) The H-reflex was absent in 30 alcoholics(71.4%) among 42 alcoholics. 5) On the EMG, such abnormal findings as the fibrillation potentials and/or positive sharp waves in rest, and the decreased numbers of motor unit action potentials and increased polyphasic potentials in volition of limb muscles were found in 15(31.9%) out of 47 alcoholics. 6) The alcoholic neuropathies were not correlated with variables like age, duration of alcohol drinking, severity of alcohol dependence, cognitive deficit, hepatic dysfunction, anemia and serum folic acid and lipid metabolism. In conclusion, the prevalence of subclinical neuropathies in alcoholics seemed to be much higher beyond expectation. The electrophysiological studies highly suggested that the cause of neuropathies was the direct neurotoxic effect of alcohol that might exert axonal degeneration.