Beers and Brains

How alcohol can affect the human Nervous System

Goals

• Knowing basic points on circuits of addiction

• How alcohol manipulates these circuits

• What are the effects of a single drink

• What are the effects of chronic alcoholism

• Some diseases of the CNS caused by alcohol

Meet your nucleus accumbens

the DOLMA principle

• You do something , eating DOLMA as an example

• dolma is a good meal

• Your nucleus accumbens will release dopamine after you eat a good meal or do something pleasant

• Dopamine makes you feel great

• You liked this feeling

• You try to repeat this feeling by begging your mother to make another Dolma next Friday .

The reward circuit

• Nucleus Accumbens is part from the mesolimbic system ( the major dopaminergic pathway of brain)

• Where your most primitive desires are kept

• Food , sex and other gratifying behaviours

• Drugs and alcohol play with the ( dopamine release ) from these circuits

• Alcohol make N. Acc. Release more dopamine

Controltaking

• Your thinking , your higher functions , your sensory perception , your balance and memory , your emotions and your logical judgment

• directly influenced by the reward circuits

Alcohol is controlling brainspeople like to have their brains controlled

Alcohol and neurotransmitters

• Inhibition of acetylcholine release

• Increase release of dopamine (happy)

• Enhancing GABA neurotransmission ( GABA has inhibitory action on neurons)

• Ca-k channel inhibition

• Decreasing glutamate levels ( excitatory)

guess what these changes can cause?

Acute effects of alcohol

• Euphoria

• CNS depression

• Disinhibition

• Poor judgment

• Decreased memory and concentration

• Decreased reflexes

• More prone to falls , RTAs

• Emotional outbursts

Yeah !

Regions affected

Is alcohol healthy ?

Its all related to the amount being consumed

If moderate : healthy

If excessive : unhealthy

Measuring alcohol

Alcohol is measured in units

Each unit contain 8 grams of absolute alcohol

Each unit needs 1 hour to be metabolized in liver

Up to 21 units / week / for men is good

Up to 14 units / week / for women

Liver needs :

Units

Men and women

Moderate is good

Moderate is good

Moderate is good

Excessive is bad

• Definition of Alcoholism : maladaptive alcohol use with clinically significant impairments

Acute alcohol poisoning

Medical ER

High levels of alcohol in blood sufficient to

induce coma , respiratory depression and

death !!

Signs and symptoms :

Severe confusion, stupor , unconsciousness

Vomiting while unconscious , seizures ,

decreased resp. rate , central cyanosis

Acute alcohol poisoning

• Diagnosis : clinical then for alcohol levels in blood .

• Managing : ABC

Important to ensure Airway, tongue, vomitus ..

If unconscious : intubate

Breathing : give O2

Circulation : check O2 sats

Acute alcohol poisoning

• Also :

Treat hypoglycemia if present by 50% glc water

Give thiamine to prevent Wernickes – Korsakoff syndrome

Treat nausea , anxiety , tremor

Hemodialysis if severe intoxication

Chronic alcoholism

• Memory impairment

• Ataxia

• Vision changes

• Depression

• Irritability

• Sleep disorders

• Anxiety

Imaging

imaging

Effects of alcohol depend on

• Frequency of drinking

• Quantity of drinking

• Age onset of drinking

• Duration of drinking

• Gender

• Genetic factors

• Family history of alcoholism

• Diet and general health

Chronic effects of alcohol / diseases

• Withdrawal

• Wernicke's – Korsakoff syndrome

• Alcoholic neuropathy

• Alcoholic cerebellar degeneration

• Alcoholic myopathy

• Fetal alcohol syndrome

• Dementia

• Neurological manifestations of liver disease

Withdrawal

• Sudden cessation of drinking

• Hyper excitability of the nervous system

• Insomnia , agitation , delerium , auditory and visual hallucinations

• Autonomic hyperactivity ( BP , heart rate …)

• Usually 6-8 hours after abstinence

• May lead to seizures (grand mal seizures)

Management of withdrawal

• Treat associated electrolyte abnormalities .

• Correct hyperthermia

• Fluid replacement

• Sedation with tapered dose of BDZ for 5 days

syndromeWernicke - Korsakoff

• Thiamine deficiency in alcoholics ( and others)

• Initial phase is Wernicke which is triad of :

• Mental confusion

• Oculomotor disturbance

• Cerebellar ataxia

• May progress to stupor , coma or even death if undiagnosed or untreated well

• Nystagmus , 6th palsy , Gait ataxia

syndromeWernicke - Korsakoff

• Korsakoff Follow the Wernickes encephalopathy• Retrograde and anterograde amnesia and other

features .

• Rx of w-k syndrome :• Iv thiamine 100 mg for 5 days• Alcohol Detox prophylaxis (BDZ)• (Fluid is N/S) never give GLC water• Daily oral thiamine 1oo mg after discharge

Peripheral neuropathy

Peripheral neuropathy

• Distal ,sensory or sensory-neural polyneuropathy

• Tingling sensations , burning pain in the extremities

• Sometimes distal muscle weakness and atrophy

• Ankle reflex diminished

• Autonomic disturbances (impotence , sweating abn. ….)

Alcoholic cerebellar degeneration

• Slowly progressive cerebellar degeneration

• Occurs in severe alcoholics

• Anterior and superior vermis is involved

• Ataxic , wide based gait

Alcoholic myopathy

• Chronic painless syndrome of proximal muscle weakness and wasting

• Usually after several days of heavy binge drinking

• maybe severe , leading to rhabdomyolysis and hyperkalemia

Fetal alcohol syndrome

• Happens in infants of alcoholic mothers

• Prenatal ethanol exposure impairs fetal growth and development

• distnictive dysmorphic features :

1. Short palpebral fissures

2. Thin upper lip

3. Flat midface

4. Short stature and microcephaly

5. Mental retardation

Fetal alcohol syndrome

Hepatic encephalopathy

• Liver is diseased, cant metabolize ammonia

• High ammonia levels in the brain

• Ammonia enhance release of GABA in the brain

• GABA is inhibitory for neurons

• Change in sleeping pattern , psychological changes , then disturbances in level of consciousness .

Others

• Alcoholics more susceptible to falls ( subdural hematomas and brain cuncussions)

• Injuries to peripheral nerves ( Saturday night palsy)

• Road traffic accidents

• Crimes

In summary

• Reward circuits are crucial for life , and very important in neurobiology of addiction.

• The dolma principle of addiction

• Alcohol plays with neurotransmitters to control the brains

• Effects are either acute or if long-standing : chronic and lead to many diseases

Answer to the question (how can you link these 3 pictures by

1 word)

The answer was

DOPAMINE

Winners !!

• Reem Hussein

• Zahraa Sabri

• Zaid Joseph

THANK YOURushd J. S. Alshammaa

Zubaida Emad

Rouaa Amer