Disulfiram Neuropathy: Two Case Reports

Anh Thu Tran; Richard A. Rison; Said R. Beydoun

Disclosures

J Med Case Reports. 2016;10(72) 

In This Article

Conclusions

Disulfiram neuropathy occurs in patients who have a history of chronic alcohol use. The frequency with which it occurs is difficult to assess, though one quoted figure is 1:15,000.[5,7] The challenge in determining disulfiram as the causative agent is that concomitant alcohol-related neuropathy is often a confounding factor; thus, disulfiram neuropathy is likely under-diagnosed and attributed to alcohol neuropathy. Often, clinicians must rely on the timing of neuropathic complaints with respect to disulfiram administration. As with case 1, our patient had sensory complaints prior to starting disulfiram therapy; however, she experienced acute worsening of her symptoms after initiating therapy at a time when she was abstaining from alcohol. Additionally, her symptoms improved with cessation of disulfiram. In case 2, our patient's neuropathic symptoms clearly developed after she started disulfiram therapy. Her symptoms improved over the course of 2 months after the cessation of therapy. Because the underlying neuropathy due to alcohol is a confounder, we propose further study of the potential effects of disulfiram on peripheral nerves. One method to study this would be to perform electrodiagnostic studies prior to initiating disulfiram therapy to obtain a baseline. Neuropathy and electrodiagnostic findings of decreased CMAP to indicate axonopathy after disulfiram therapy can then be attributed to disulfiram with greater confidence, given that patients will have abstained from alcohol during disulfiram therapy. Another useful study may be to perform a sensory nerve biopsy to determine if small fiber sensory nerves are involved.

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