Comparative analysis of Electromyoneurographic findings in Alcoholic and Disulfiram Polyneuropathy

Introduction: Alcoholic polyneuropathy (AP) is relatively common among alcoholics. Disulfiram polyneuropathy (DP), since 1948. year (when this therapy was introduced in alcoholics treatment), was relatively rare registered in alcoholics. AP and DP together are classified in a group of toxic neuropathies, but the electromyoneurographic (EMNG) differentiation between them was not precisely defined yet. Aims of research: To compare EMNG findings in two similar age groups of patients with AP and DP and to define differences between them. Patients and methods: We analysed EMNG of 60 patients with AP, average age 42.2 (42.2 +/- 8.9) years, and 20 patients with DP, average age 39.3 (39.3 +/- 9.4) years. All 20 patients with DP had EMNG examination before disulfiram treatment onset and no signs of neuropathy were registered. Patients in both groups (with AP and DP) were males. For electroneurografic (ENG) examination we used surface electrodes, and we registered motor (MCV) and sensory conduction velocities (SCV) values (in m/s) of peroneal (PN) and tibial nerves (TN), their distal latencies (DL-PN and DL-TN) values (in ms) and minimal F-wave (F-PN and F-TN) latencies (in ms) after 40 repetitive stimulations of those nerves. SCV of PN and TN was determined by antidromic techique. After ENG examination, electromyographic (EMG) examination of legs muscles, with coaxiale needle electrodes was performed. We used t-test and Pearson bivariate correlation (sig. 2-tailed) for statistical analysis. Results: In 14/60 (23.33%) patients with AP and 20/20 (100%) patients with DP we registered signs of denervation activity (fibrillations, positive denervation waves etc.) in feet muscles. In 4/60 (6.67%) patients with AP and 5/20 (25%) patients with DP we registered motor and/or sensory nerve impulse conduction absence in distal segments of PN and/or TN. DL-PN, DL-TN and F-PN values were statistically significant higher in patients with DP versus AP (p<0.001), but MCV-PN, SCV-PN, MCV-TN and SCV-TN values were statistically significant lower in patients with DP versus AP (p<0.001). Correlation between MCV-TN and F-TN values, and between MCV-PN and F-PN values was statistically significant (p<0.001) only in patients with AP, but not in patients with DP. Conclusion: We registered electrophysiological signs of severe lesions of PN and TN motor and sensory axons in majority of patients with DP, and signs of denervation activity in feet muscles in all analyzed patients with DP, what is about four times more frequent in patients with DP versus AP. Signs of nerve impulse conduction absence in distal parts of PN and/or TN we registered in one fourth of analyzed patients with DP, what is about four times more frequent than in patients with AP. Different EMNG findings in patients with DP and AP indicate that those forms of neuropathy represent different subtypes of axonopathy, DP- distal axonopathy and AP- chronic sensorimotor axonal neuropathy.