Alcohol-related autonomic dysfunction and peripheral neuropathy

Both peripheral neuropathy and autonomic dysfunction are known consequences of chronic and excessive alcohol consumption. The prevalence of peripheral neuropathy among chronic alcohol abusers is 46.3% (CI 35.7%–57.3%) when confirmed via nerve conduction studies. Alcohol-related peripheral neuropathy is generally described as a progressive, predominantly sensory axonal length-dependent neuropathy. Based on cardiovascular reflex tests, 16%–73% of the chronic alcohol abusers suffer from autonomic dysfunction. Erectile dysfunction is the most commonly reported feature. The most important risk factor for both conditions is total lifetime dose of ethanol. There is also evidence that other risk factors have been identified in the pathogenesis of peripheral neuropathy due to alcohol abuse including genetic factors, male gender, and type of alcohol consumed. There is limited evidence for other environmental risk factors in the pathogenesis of alcohol-induced autonomic dysfunction. Currently, there is limited evidence regarding the management for both conditions, but sparse data support abstinence to lead to a significant improvement in autonomic dysfunction and the use of B-vitamin supplementation including thiamine to be promising in the management of alcohol-induced peripheral neuropathy.