Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders

Abstract

Wernicke encephalopathy is an acute, reversible neuropsychiatric emergency due to thiamine deficiency. Urgent and adequate thiamine replacement is necessary to avoid death or progression to Korsakoff syndrome with largely irreversible brain damage. Wernicke Korsakoff syndrome refers to a condition where features of Wernicke encephalopathy are mixed with those of Korsakoff syndrome. Although thiamine is the cornerstone of treatment of Wernicke encephalopathy, there are no universally accepted guidelines with regard to its optimal dose, mode of administration, frequency of administration or duration of treatment. Currently, different dose recommendations are being made. We present recommendations for the assessment and treatment of Wernicke encephalopathy based on literature review and our clinical experience.

Wernicke Encephalopathy and Other Vitamin Deficiencies in a Patient with Home Parenteral Nutrition

“…Although different therapeutic options exist, it is accepted that the treatment should consist of 250-500 mg three times per day for the first 3-5 days, and if there is an improvement, 250 mg iv once per day for the next 3-5 days, moving finally to 100 mg orally en those patients who tolerate it. 9,14 Although sometimes incomplete, in general the response to treatment is rapid, with ophthalmoparesis being the first symptom tor resolve, followed by a partial or total improvement of confusional syndrome, with a certain degree of ataxia persisting in up to 50% of cases, 15 as occurred with our patient. She recovered as well from the confusional syndrome as from the diplopia in less than 24 hours, remaining with a certain degree of residual ataxia and gait instability.…”

“…9 However, imaging diagnosis can be useful in providing evidence of WE and help eliminate possible alternative diagnoses. CT scan can show small, symmetrical signs of low density in the diencephalon, midbrain and periventricular regions which are enhanced after the administration of contrast.…”

Thiamine Prescribing Practices for Adult Patients Admitted to an Internal Medicine Service

“…3 Chronic alcohol use is one of the most common predisposing factors for WE. 2,5 WE has been reported to occur in 12.5% of those with chronic alcohol use, although it is widely suspected that this is an underestimate of the true prevalence of the disorder. 6,7 Importantly, WE can cause substantial morbidity and mortality if left untreated, leading to death in up to 20% of cases and progression to Korsakoff psychosis in 85% of survivors, of whom 25% require long-term institutionalization.…”

“…3 Historically, the treatment for WE has been thiamine 100 mg IV daily for 3-5 days, although this regimen has not been tested in any randomized controlled trials. 2,5 The European Federation of Neurological Societies (EFNS) guidelines for diagnosis, therapy, and prevention of WE suggest thiamine 200 mg IV 3 times daily until there is no further improvement in signs and symptoms. 11 The Royal College of Physicians (RCP) guideline on management of WE in the emergency department recommends thiamine 500 mg IV 3 times daily for 3 days.…”

Wernicke–Korsakoff syndrome

“…Неотложная -с началом в течение 48-72 ч после появ-ления первых симптомов -и адекватная заместительная те-рапия тиамином позволяет избежать смертельного исхода энцефалопатии Вернике и ее перехода в корсаковский пси-хоз, при котором мозговое повреждение часто принимает необратимый характер [11,12].…”