Wernicke’s encephalopathy in exclusive breastfed infants

Bhat, Javeed I.; Ahmed, Qazi Iqbal; Ahangar, Ambreen Ali; Charoo, Bashir Ahmed; Mushtaq, Sheikh; Syed, Wajid Ali

doi:10.1007/s12519-017-0039-0

Cited by 20 publications

(20 citation statements)

References 12 publications

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“…30 Studies from this region have reported high incidence of infantile Wernicke's encephalopathy and thiamine responsive lactic acidosis in exclusively breast-fed infants. 7 This again highlights the state of thiamine deficiency of breast-feeding mothers, which is a reflection of the nutritional status of general population.…”

Section: Discussionmentioning

confidence: 96%

“…5,6 Similarly it has been described in children presenting as encephalopathy which was thiamine responsive. 7 As for neurologists; thiamine deficiency has been reportedly increasingly in both of its forms viz neuropathy and Wernicke's encephalopathy. 8,9 The presence of wet Beri-beri in adults suggests thiamine deficiency in general population.…”

Section: Introductionmentioning

confidence: 99%

“…While as Wernicke's encephalopathy in exclusively breast bed infants suggests a maternal thiamine deficiency. 7 The central nervous system is considered more likely to be affected when the thiamine deficiency is severe and abrupt, whereas the peripheral nerves are usually disturbed by a long-term thiamine deficiency. 10 In a hospital based study done in Kashmir, Mohsin N et al, found that out of 106 patients of acute flaccid paralysis, eight patients had neuropathy because of thiamine deficiency, out of which 6 were females.…”

Section: Introductionmentioning

confidence: 99%

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Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Ahmad¹,

Ahmad²,

Jan

2019

Int J Adv Med

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Background: Beri Beri is still seen in Asian countries due to the large-scale consumption of thiamine depleted polished rice. Thiamine deficiency related disorders are increasingly being reported from Kashmir from last two decades. Specifically, a sensorimotor axonal neuropathy occasionally develops from thiamine deficiency and may occur even without associated Wernicke’s encephalopathy.Methods: This study is a retrospective observational study. All peripartum females referred to our departments from January 2016 to December 2017 with complaints of generalized weakness and or sensory symptoms in form of paresthesias /numbness in limbs were enrolled. Clinical features, electrophysiological features, course in hospital and response to treatment in suspected thiamine deficiency related neuropathy patients were recorded.Results: Forty-three cases were included in the study. Twenty-nine patients were suspected to have nutritional neuropathy because of thiamine deficiency at the time of admission. Out of these 27 showed improvement on treatment with thiamine.Conclusions: Thiamine responsive neuropathy is common in peripartum women of this part of world. Diagnosis is usually made clinically, in at risk individuals presenting with characteristic clinical features.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Ahmad¹,

Ahmad²,

Jan

2019

Int J Adv Med

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“…Bhat et al reported on the treatment outcomes of 50 exclusively breastfed infants with a mean age of 3.2 months presenting with Wernicke's encephalopathy in Kashmir. 58 Following 100 mg/day intravenous infusion, there was a rapid improvement in symptoms, including blepharoptosis and irritability, although patients with associated aphonia were slow to respond. Neurologic abnormality at discharge, after a median of 6 days in hospital, in the form of aphonia and motor deficit, was observed in 16% of infants.…”

Section: Infants and Childrenmentioning

confidence: 99%

Thiamine deficiency disorders: a clinical perspective

Smith

Johnson

Koshy³

et al. 2020

Annals of the New York Academy of Sciences

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Thiamine is an essential water‐soluble vitamin that plays an important role in energy metabolism. Thiamine deficiency presents many challenges to clinicians, in part due to the broad clinical spectrum, referred to as thiamine deficiency disorders (TDDs), affecting the metabolic, neurologic, cardiovascular, respiratory, gastrointestinal, and musculoskeletal systems. Concurrent illnesses and overlapping signs and symptoms with other disorders can further complicate this. As such, TDDs are frequently misdiagnosed and treatment opportunities missed, with fatal consequences or permanent neurologic sequelae. In the absence of specific diagnostic tests, a low threshold of clinical suspicion and early therapeutic thiamine is currently the best approach. Even in severe cases, rapid clinical improvement can occur within hours or days, with neurological involvement possibly requiring higher doses and a longer recovery time. Active research aims to help better identify patients with thiamine‐responsive disorders and future research is needed to determine effective dosing regimens for the various clinical presentations of TDDs. Understanding the clinical diagnosis and global burden of thiamine deficiency will help to implement national surveillance and population‐level prevention programs, with education to sensitize clinicians to TDDs. With concerted effort, the morbidity and mortality related to thiamine deficiency can be reduced.

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“…Neurological presentations of TDD potentially require higher therapeutic doses and a longer recovery time. Among exclusively breastfed infants (mean age 3.2 months) treated with daily 100 mg intravenous thiamine for Wernicke’s encephalopathy, neurological abnormality at discharge, after a median of 6 days in hospital, in the form of aphonia and motor deficit was observed in 16% of infants (Bhat et al 2017a…”

Section: Treatment Of Thiamine Deficiency Disordersmentioning

confidence: 99%

Infantile thiamine deficiency in South and Southeast Asia: An age‐old problem needing new solutions

Smith

Hess

2021

Nutrition Bulletin

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Infantile beriberi, a potentially fatal disorder caused by thiamine deficiency, is often viewed as a disease confined to history in regions of the world with predominant white rice consumption. Recent case reports have, however, highlighted the persistence of thiamine deficiency as a cause of infant mortality in South and Southeast Asia. Low infant thiamine status and incidence of beriberi is attributable to maternal thiamine deficiency and insufficient breast milk thiamine. Poor dietary diversity, food preparation and cooking practices and traditional post-partum food restrictions likely play a role in these high-risk regions. Given the contribution of thiamine deficiency to infant mortality and emerging evidence of long-lasting neurodevelopmental deficits of severe and even subclinical deficiency in early life, public health strategies to prevent thiamine deficiency are urgently needed. However, efforts are hampered by uncertainties surrounding the identification and assessment of thiamine deficiency, due to the broad nonspecific clinical manifestations, commonly referred to as thiamine deficiency disorders (TDD), that overlap with other conditions resulting in frequent misdiagnosis and missed treatment opportunities, and secondly the lack of readily available and agreed upon biomarker analysis and cutoff thresholds. This review will discuss the key challenges and limitations in the current understanding of TDD and explore how ongoing initiatives plan to fill persistent knowledge gaps, namely in the development of a standardised case definition to help more accurately diagnose and treat TDD in low-resource settings. Given more attention and ensuring greater recognition of TDD will support the design and implementation of treatment and prevention programmes, and ensure beriberi can truly be considered 'the forgotten disease of Asia'.

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Wernicke’s encephalopathy in exclusive breastfed infants

Abstract: In exclusively breastfed infants, we observed acute infantile encephalopathy with epidemiological, clinical, biochemical, and radiological features suggestive of infantile Wernicke's encephalopathy and a favourable therapeutic response to thiamine supplementation during the acute stage.

Cited by 20 publications

References 12 publications

Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Thiamine deficiency related peripheral neuropathy in peripartum women of Kashmir, India: a hospital based study

Thiamine deficiency disorders: a clinical perspective

Infantile thiamine deficiency in South and Southeast Asia: An age‐old problem needing new solutions

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