Efficacy of Thiamine in Patients with Clinically Suspected Dry Beriberi: An Open Labeled Hospital Based Study

Abstract

Background: Thiamine deficiency-related disorders are increasingly being reported in countries where polished rice is the main dietary constituent and diet is not balanced in calorie, protein, and micronutrient contents. Thiamine deficiency often associated with sensory-motor neuropathy (dry beriberi) without Wernicke’s encephalopathy and cardiac dysfunction. Objectives: The objective of our study is to evaluate the efficacy of thiamine in patients with suspected dry beriberi. Methods: This study was a prospective, open-labeled, self-controlled clinical trial (quasi-experimental study) carried out in the Neurology and Medicine Ward of Chittagong Medical College Hospital from May 2018 to April 2019. Fifty-five (55) patients of suspected dry beriberi were recruited as per inclusion and exclusion criteria. All patients were given 200mg IV Thiamine HCl per day for 1 week, then oral Tab. Thiamine 100mg twice daily for the remaining 11week. They were evaluated clinically before treatment and followed up at the end of 1 week, 6 weeks, and 12 weeks after treatment. Results: There is a significant improvement of leg swelling (p<0.001), muscle cramp (p<0.001), muscle power (p<0.001), the total score of the Overall Neuropathy Limitation Scale (ONLS) (p<0.001) within 1 week of thiamine replacement. The treatment also successfully reduced individual components of sensory impairment (i.e., pain, touch, position, vibration) from baseline to 12 weeks (p<0.001). Only deep tendon reflexes did not return to normal in all patients within 12 weeks. Long-time follow-up is needed for this. Conclusion: Thiamine deficiency should be actively considered as a possible cause of peripheral neuropathy and variability of its clinical features should be taken into consideration. Thiamine is highly effective in reversing most of the clinical features of its deficiency-related peripheral neuropathy. Creating public health awareness about this disease in the community will lead to early diagnosis and treatment.