Korsakoff's syndrome is preventable

Abstract

Wernicke-Korsakoff syndrome (WKS) is a life-threatening neuropsychiatric disorder caused by thiamine (vitamin B1) deficiency. Wernicke-Korsakoff syndrome is associated with mammillary body edema and small vessel ischemia. Many patients who develop WKS have a history of serious alcoholism and self-neglect. It is a common condition as around 15% of the alcoholics show specific WKS neuropathology. Originally, the syndrome was described as a triad of ataxia, eye movement disorders, and mental status change, but recent studies have suggested that patients frequently only show the mental status change [1]. Although it has been known for over 60 years that treatment with high doses of parenteral (intravenous or intramuscular) thiamine replacement therapy has the potency to improve the neuropsychiatric syndrome in the early stage of WKS [2], this is still uncommon medical practice. Recently published studies on treatment perspectives of WKS in general and psychiatric hospitals are alarming: European as well as American studies demonstrated that most patients did not receive thiamine at all or only received it orally in low doses [3] and [4]. Both types of treatment lead to unnecessary cases of chronic WKS (also Korsakoff's syndrome) characterized by severe amnesia and lifelong impaired autonomy [4]. Based on the currently available literature, we suggest that any sign of mental confusion, cognitive defect, or change in mobility in an admitted alcoholic should alarm a clinician for treatable WKS. Parenteral thiamine replacement therapy is well tolerated and regularly ameliorates neuropathology in WKS. According to the European Federation of Neurological Societies and the Royal College of Physicians, parenteral thiamine should be given 200 mg up to 500 mg 3 times daily until symptoms of acute WKS resolute [5]. Importantly, in many cases, the benefit of treating WKS outweighs the risks of treating unnecessarily. The treatment is lifesaving and has the potential to reverse this acute neuropsychiatric syndrome. It is recommended to have a high suspicion of WKS in alcoholic patients and preventively treat them as such.