High-dose thiamine strategy in Wernicke-Korsakoff syndrome and related thiamine deficiency conditions associated with alcohol use disorder

Abstract

Thiamine is essential for the activity of several enzymes associated with energy metabolism in humans. Chronic alcohol use is associated with deficiency of thiamine along with other vitamins through several mechanisms. Several neuropsychiatric syndromes have been associated with thiamine deficiency in the context of alcohol use disorder including Wernicke-Korsakoff syndrome, alcoholic cerebellar syndrome, alcoholic peripheral neuropathy, and possibly, Marchiafava-Bignami syndrome. High-dose thiamine replacement is suggested for these neuropsychiatric syndromes.

Keywords: Alcohol use disorder; Marchiafava–Bignami syndrome; Wernicke–Korsakoff syndrome; alcoholic cerebellar syndrome; alcoholic peripheral neuropathy; thiamine.

Figure 1

Thiamine recommendations for patients with alcohol use disorder. ^aHistory of alcohol use, but no clinical features of WE; ^bNo clinical features of WE, but with risk factors such as complicated withdrawal (delirium, seizures); ^cClinical features of WE (ataxia, opthalmoplegia, global confusion)