People with severe alcohol dependence will need medical support to stop drinking. Without this support they will be at risk of severe complications. The potential for withdrawal symptoms in the aftermath of sustaining a brain injury is high in those with pre-existing alcohol dependency. Therefore in the early stages following brain injury, medical intervention to reduce the risk of severe complications is imperative.
In order to reduce risks it is important that the individual is prescribed benzodiazepines to assist their withdrawal from alcohol, the dose of benzodiazepines ideally being adjusted to the person’s individual requirements (indicated by close monitoring of their experience of withdrawal symptoms). In addition, because alcohol dependence is commonly associated with poor diet and impaired utilisation of nutrients, they will also require nutritional supplementation. The most important vitamin deficiency commonly experienced by people with severe alcohol dependence is thiamine. This deficiency can lead to them experiencing Wernicke’s Encephalopathy which is a medical emergency: alcohol withdrawal being a particularly high risk time for this to occur. Wernicke’s Encephalopathy can be fatal.
Symptoms of Wernicke ’s Encephalopathy may include:
- Ataxia (poor coordination, with walking being particularly affected).
- Confusion.
- Apathy.
- Ophthalmoplegia (impaired eye movements with the ability to look to the side being most commonly affected).
- Nystagmus (involuntary movements of the eyes).
If Wernicke’s Encephalopathy is inadequately treated this can lead to serious and enduring memory problems in those who survive. This state of persistent memory impairment is called ‘Korsakoff’s Syndrome’ which is characterised by profound retrograde amnesia and anterograde amnesia, the person losing all memory for a variable period before the episode of Wernicke’s Encephalopathy and having an impaired ability to form new episodic memories.
In order to avoid the development of Korsakoff’s Syndrome, an individual with a history of very high alcohol consumption and/or malnutrition should receive prophylactic treatment with Pabrinex (the parenteral preparation of Thiamine available in the UK). Prophylactic dosing is generally recommended as one pair of ampoules once daily for five days.
An individual with symptoms suggestive of Wernicke’s Encephalopathy should receive a treatment regime of this Pabrinex i.e. two pairs of ampoules three times a day for three days, with ongoing once-daily treatment if a response is still being observed.
It is likely that many people who misuse alcohol have experienced relatively mild or subacute episodes of Wernicke’s Encephalopathy which did not come to medical attention. However, it is now well established that heavy alcohol use, even in the absence of thiamine deficiency, can itself lead to cognitive problems. The individual with this form of (non-Korsakoff’s) alcohol-related brain damage (ARBD) may often be especially impaired in the area of executive functioning. However most people with alcohol-related brain damage experience both episodic memory problems and impaired executive functioning with impairment in some tests of visuospatial functioning also evident.
Please note that cognitive deficits associated with alcohol use and with brain injury can actually be very similar: memory problems and impaired executive functioning are often common to both. Distinguishing which cognitive impairments are due to alcohol and which are due to brain injury may be difficult or even impossible.