Early-Onset Alcohol Dependence and Multiple Sclerosis: Diagnostic Challenges

Abstract

Multiple sclerosis (MS) is an inflammatory demyelinating disorder characterized by the progressive disruption of the myelin sheath around the nerve fibres. The early initiation of disease-modifying treatments is crucial for preventing disease progression and neurological damage. Unfortunately, a diagnostic delay of several years is not uncommon, particularly in the presence of physical and mental comorbidities. Among psychiatric comorbidities, the role of alcohol misuse is still under debate. In this paper, we discuss a case of early-onset alcohol dependence and its possible role in delaying the initiation of a specific therapy for MS. The differential diagnosis between idiopathic and secondary neurodegenerative disorders is often challenging. When dealing with patients reporting an early-onset substance abuse (likely to present organic damage), clinicians may be prone to formulate a diagnosis of secondary neuropathy, particularly when facing non-specific symptoms. This case report highlights the need for in-depth medical investigations (including imaging) in the presence of neurological signs suggesting a damage of the central nervous system, prompting a differential diagnosis between idiopathic and secondary neurodegenerative conditions. Indeed, a timely diagnosis is crucial for the initiation of specific therapies positively affecting the outcome.

Efficacy of different intensity of aquatic exercise in enhancing remyelination and neuronal plasticity using cuprizone model in male Wistar rats

“…8 At times, neurodegenerative disorders following substance abuse can mimic features of MS, which needs careful evaluation. 9 Potential biomarkers, such as myelin basic protein (MBP), glial fibrillary acidic protein (GFAP) and CNPase, can play a role in the diagnosis and assessment of therapeutic agents in MS. 10,11 Cuprizone (bis-cyclohexanone oxaldihydrazone; Cup) has been successfully used for inducing demyelination. 12 It is a primary copper chelator which causes selective apoptosis of oligodendrocytes and induces CNS demyelination in rats.…”

Comorbidities in Patients with Multiple Sclerosis and How Lifestyle Behaviors Can Change the Comorbidities, Role of the Family Physician and Neurologist

“…There are other pathologies that can occur, however, they have not yet been sufficiently studied, like alcohol and illicit drug use and bipolar disorder with a prevalence of 0 to 16.2 % [28]. It´s not a clear prevalence of alcohol intake but the estimated is 3.96% to 18.2% [29].…”

“…It´s not a clear prevalence of alcohol intake but the estimated is 3.96% to 18.2% [29]. A case report suggests that the early onset of substance abuse likely to present organic damage [28].…”

Influence of Genetic Polymorphisms on Clinical Outcomes of Glatiramer Acetate in Multiple Sclerosis Patients

“…Its diagnosis is based on medical history and neurological examination but, due to the heterogeneity of MS symptoms and the variable outcomes, an accurate diagnosis is currently challenging [ 9 , 10 ]. Numerous cerebrospinal fluid biomarkers are proposed for the diagnosis and prognosis of the disease, such as oligoclonal bands, oxidative enzymes and the IgG index, but only a few are clinically implemented [ 6 , 7 , 8 , 11 , 12 ].…”