A L C O H O L C O N C E R N Wernicke-Korsakoff’s syndrome Factsheet 6 SUMMARY ALCOHOL CONCERN is the national agency on alcohol misuse, working to • This factsheet describes Wernicke-Korsakoff’s syndrome and reduce the level of alcohol related conditions. It also looks at the service and treatment misuse and to develop the needs of people affected by this syndrome. range and quality of helping services available to problem • Wernicke-Korsakoff syndrome is caused by lack of thiamine drinkers and their families. (vitamin B1) which is a common condition amongst heavy We are England’s primary drinkers source of information and comment on a wide range of • The syndrome is made up of two separate, but related disorders: alcohol-related matters. Wernicke’s encephalopathy (WE) and Korsakoff’s psychosis (KP) The Alcohol Concern Information and • The main symptoms of Wernicke-Korsakoff’s syndrome are loss Communications Team of memory, confusion about time and place, drowsiness, loss of provides a range of services spontaneity and poor balance including: producing its research bulletin Acquire and • Post-mortem studies suggest that Wernicke-Korsakoff’s the Alcohol Magazine and syndrome occurs in about 2% of the general population and website, and collating and 12.5% of dependant drinkers interpreting the latest research in order to produce • WE usually occurs before KP develops factsheets. The team also provides a telephone • If WE is not treated in the early stages if can result in permanent information line and a unique brain damage or severe short-term memory loss (ie KP) library of alcohol related literature. • WE is a difficult condition to diagnose as symptoms can be mistaken for drunkenness Alcohol Concern’s telephone information line is open Monday - Friday, • WE can be treated by high-dose injections of thiamine (for 1.00pm – 5.00pm on: dosage recommendations see ref. 1). The patient who receives Tel: 020 7922 8667 thiamine in this way can recover fully and be left with no memory Email: problems, although this is not guaranteed. [email protected] • Overall Wernicke-Korsakoff’s syndrome should be viewed as a treatable condition. The question of how successful treatment of Alcohol Concern someone with Korsakoff’s psychosis will be depends on the 64 Leman Street degree of damage done to the brain. London E1 8EU Tel: 020 7264 0510 Fax: 020 7488 9213 Website: www.alcoholconcern.org.uk This is a summary of a detailed factsheet which is available from Factsheet updated the information unit. Many other factsheets are also available. 2001 ALCOHOL CONCERN Factsheet 6: Wernicke-Korsakoff syndrome This factsheet describes Wernicke-Korsakoff syndrome and related conditions. It also looks at the service and treatment needs of people affected by this syndrome Wernicke-Korsakoff Who develops it? syndrome Post-mortem studies suggest that the Wernicke-Korsakoff syndrome occurs in about Wernicke-Korsakoff 2% of the general population and 12.5% of dependent drinkers (1). The vast majority syndrome (WKS) is a form of sufferers develop the syndrome as a result of malnutrition caused by heavy of brain damage associated drinking over time, however it is important to note that it is also possible to develop with alcohol misuse. The Wernicke-Korsakoff syndrome without consuming alcohol, although this is rarer. syndrome is made up of two Workers in alcohol services report that the syndrome affects people in their thirties, separate, but related forties and fifties as well as those in older age groups. disorders: Wernicke’s encephalopathy and Korsakoff’s psychosis. Wernicke’s encephalopathy The syndrome is named after the two people who Wernicke’s encephalopathy can develop quite suddenly and the symptoms are easy first described the to miss or mistake for straightforward drunkenness. It has been reported that 17- conditions. Karl Wernicke, a 20% (3) of people who develop Wernicke’s encephalopahty die because of the Polish neurologist, published condition and that 85% of survivors go on to develop Korsakoff’s psychosis (3). his description of Wernicke’s Because the condition is difficult to spot, it is often only revealed by post-mortem encephalopathy in 1881 and examinations. Sergei Korsakoff, a Russian psychiatrist, published the The symptoms of Wernicke’s encephalopathy are: first of a number of papers confusion about time and place describing the condition drowsiness which bears his name in poor balance 1887. double vision abnormal eye movements or paralysis of eye muscles that might seem like a The most widely recognised squint characteristic of the syndrome is loss of memory. Not all of the above symptoms will necessarily be present in every case and the Wernicke’s encephalopathy person with Wernicke’s encephalopathy may just appear to be confused for no good usually precedes Korsakoff’s reason. If they are a known drinker or smell of alcohol it is easy to see how the psychosis. The symptoms condition is difficult to diagnose. If you know how much the person has drunk, a and likely consequences of good clue the condition is developing can be that they appear more drunk than you the two conditions are would expect. different so this factsheet describes them separately. It is important that Wernicke’s encephalopathy is diagnosed as soon as possible because it can be fatal and if it is left untreated irreparable brain damage may occur (this is the second phase of the syndrome; see below). A blood test can confirm thiamine deficiency, however this may take up valuable time and it is important that Wernicke’s encephalopathy is treated with large doses of thiamine (vitamin B1) by intravenous or intramuscular injection as soon as possible. Alcohol and brain What causes Wernicke’s encephalopathy damage Heavy drinking over time is Wernicke’s encephalopathy is caused by a lack of thiamine (vitamin B1) associated with a number of different types of brain Many heavy drinkers don’t eat properly because alcohol takes the place of food. damage (2) in addition to When they do eat they can have difficulty absorbing nutrients because their Wernicke-Korsakoff stomach or liver may be damaged. This can lead to malnutrition and vitamin syndrome; these include: deficiencies. Cerebellar degeneration The body uses thiamine to form part of the structure of blood vessels, including Alcoholic dementia those in the brain. Without it they begin to leak. The main symptoms of Wernicke’s Stroke encephalopathy (confusion, drowsiness etc) occur when blood is leaking out of the Hepatic capillaries in and around the parts of the brain that form new memories and the encephalopathy parts that control muscle co-ordination. If the leaking continues the patient will Marchiafava- probably become unconscious, the leaked blood then clots and as it solidifies Bignami disease damages the brain tissue around it. Central pontine myelinolysis Treatment of Wernicke’s encephalopathy Wernicke’s encephalopathy can be treated by high-dose injections of thiamine (for dosage recommendations see ref.1). The patient who receives thiamine in this way Alcohol and thiamine can recover fully and be left with no memory problems, although this is not deficiency guaranteed. However, if the patient does not receive large doses of thiamine before Heavy drinking can cause becoming unconscious it is more likely that they will have sustained permanent gastritis which is an damage and will begin to show signs of Korsakoff’s psychosis. Signs of damage to inflammation of the the person’s memory may become obvious in a matter of weeks, or it could take stomach. If someone has longer for the symptoms to become obvious. gastritis they will often vomit Individuals who are malnourished or who have been drinking heavily will not be up food before it can be able to absorb thiamine (vitamin B1) very well through their digestive system. digested. If food does not Therefore, it is important that people who have developed Wernicke’s make it to the stomach, it encephalopathy receive high-dose intramuscular or intravenous injections of will not be absorbed thiamine rather than orally administered doses. This treatment can also prevent properly because the Wernicke’s encephalopathy from developing. Unfortunately, there has been a trend stomach is inflamed. away from prescribing this vital treatment. This is possibly due to a combination of Because it affects how factors including a warning in 1989 from the Committee on Safety of Medicines much and how well food is about possible serious side-effects from the only injectable vitamin B supplement absorbed gastritis can lead then available. It seems likely that the committee have overemphasised the risks to malnutrition and associated with injecting vitamin B and underestimated the risks and prevalence of therefore contributes to low Wernicke’s encephalopathy (3). This may be leading to an increase in the number of levels of thiamine (vitamin cases of Wernicke-Korsakoff syndrome. B1) in problem drinkers. It is important to appreciate that people with Wernicke’s encephalopathy may come The liver is a complex into contact with doctors and health professionals in a wide variety of situations and organ with many vital roles. for a range of reasons. For example someone who has burnt themselves whilst It can affect the body’s drunk may be admitted to a burns unit and the symptoms may not be identified as a ability to absorb and store separate condition. Because high-dose injections of thiamine can both prevent and nutrients such as thiamine. successfully treat Wernicke’s encephalopathy, it is vital that health professionals, There are 3 stages of liver and others who work with people who misuse alcohol, are able to identify the damage associated with condition and the risk factors associated with it so that sufferers and people likely to heavy drinking: develop it can be appropriately treated.