Peter R. Martin: Historical Vocabulary of Addiction.
Hector Warnes response to Peter Martin’s reply to his comment
I am most grateful to Peter Martin for his outstanding review of the Wernicke-Korsakoff syndrome. I have seen many cases admitted to psychiatric hospitals with partial remission in spite of high doses of Thiamine which can be monitored by the resolution of the ophthalmoplegia and ataxia (though truncal ataxia may also persist) but not necessarily of other neurological and cognitive deficits. The patients were also given Magnesium which is a co-factor for Thiamine transketolase activity; thiamine should be given prior to glucose loading for dehydration. It is estimated that more than 50% of people with Wernicke encephalopathy also get Korsakoff's syndrome. Wernicke encephalopathy may clear with Thiamine treatment or may be followed by a Korsakoff Psychosis (Dementia) which consists of an amnestic-confabulatory state without delirium.
I did not emphasize the unique role of Thiamine because most patients with this encephalopathy have other co-morbidities and lately neuroscientists have shown synergies of thiamine (B1), pyridoxine (B6) and cyanocobalamin (B12) in the integrity of the Central Nervous System. The deficiency of only one factor Thiamine was found in an animal model (Beriberi in chickens with polyneuritis). The hydrosoluble vitamins of the B group act on the myelin and neurotransmitter synthesis.
January 6, 2022