PCSS-MAUD Webinar: Neurological Conditions and MAUD-Slides

Slides

Pdf Summary

The webinar reviews major neurologic complications of alcohol use disorder (AUD) and how they influence treatment. Alcohol can injure the nervous system through direct neurotoxicity and withdrawal-related hyperexcitability, thiamine deficiency, and liver dysfunction. These mechanisms often overlap.<br /><br />Wernicke encephalopathy is an acute, treatable thiamine-deficiency emergency that may progress to lasting Korsakoff amnesia. Because the classic symptom triad is uncommon, clinicians should treat suspected cases promptly with high-dose thiamine, given before or with glucose, and correct magnesium deficiency.<br /><br />Alcohol withdrawal ranges from early symptoms to seizures and delirium tremens (DTs). Risk assessment and monitoring are essential; benzodiazepines are first-line for seizures and severe withdrawal, while refractory DTs may require phenobarbital in closely monitored care. CIWA-Ar is not appropriate once a patient is delirious. In liver disease, lorazepam, oxazepam, or temazepam are preferred over benzodiazepines with active metabolites.<br /><br />Hepatic encephalopathy (HE) is a diagnosis of exclusion in patients with liver disease. Identify and treat precipitants—such as infection, bleeding, constipation, dehydration, electrolyte abnormalities, or sedatives—alongside lactulose, titrated to two or three soft bowel movements daily. Rifaximin is generally added for recurrent HE.<br /><br />Chronic AUD may cause sensory peripheral neuropathy and cerebellar degeneration. Abstinence, nutritional repletion, physical therapy, and fall prevention are central; gabapentin or pregabalin may treat neuropathic pain but are not FDA-approved AUD treatments.<br /><br />FDA-approved medications for AUD are naltrexone, acamprosate, and disulfiram. Selection should account for liver and kidney function, cognition, and adherence. Acamprosate is often suitable in liver disease; extended-release naltrexone can help when memory or daily adherence is a concern. Stabilize acute withdrawal before starting AUD medication. When altered mental status has multiple possible causes, conditions may coexist, so clinicians should investigate and treat in parallel.

Keywords

alcohol use disorder

neurologic complications

Wernicke encephalopathy

Korsakoff amnesia

thiamine deficiency

alcohol withdrawal

delirium tremens

hepatic encephalopathy

peripheral neuropathy

AUD medications