Alcoholic Cerebellar Degeneration : Role of Corticosteroid

• one of the most common neurological complications in alcoholics¹
• Alcoholism associated cerebellar damage caused by excitotoxicity, thiamine depletion, glial abnormalities, oxidative stress, and impaired energy production, impairs balance and coordination
• Studies have also shown that alcohol-induced degradation of white matter integrity, and fiber damage in the corpus callosum, are both associated with postural instability

Treatment

• No specific guideline on the management
• Treatment is directed toward stopping further damage to the peripheral nerves and returning to normal functioning.
• These can be achieved by alcohol abstinence, a nutritionally balanced diet supplemented by all B vitamins, and rehabilitation.

Abstinence

• Some studies provide strong evidence that gait and balance are disturbed in alcohol dependent individuals following abstinence durations of 1.5 to 3.75 months²
• but also suggest that significant, albeit incomplete, recovery can occur with greatly extended abstinence, especially for gait and balance with visual support

Steroid

• No sufficient evidence on specific alcoholic cerebellar degenaration
• However are used for other related conditions with some benefits
• Based on the premise that myelinotoxic compounds and a speculative inflammatory process
• are contributing to the pathogenesis of CPM, patients have successfully been treated with plasmapheresis, intravenous immunoglobulins, and steroid administration. However, these therapies need to be studied further.
• In a case of Central pontine myelinolysis (CPM) from alcohol withdrawal, a steroid pulse therapy that was continued for 3 days and conservative management with atypical antipsychotics showed slight improvement to some degree for dysphagia, while dysarthria and prominent psychiatric symptoms showed little improvement for 1 month³
• Recently Lauria et al4 induced clinical improvement in a patient with anti-GAD-Ab cerebellar ataxia through high doses of methylprednisolone, suggesting that it should be considered as first-line therapy in these patients⁴

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/17494510
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465531/
3. http://alcalc.oxfordjournals.org/content/43/6/647
4. http://jnnp.bmj.com/content/80/1/95.extract
5. Central Pontine Myelinolysis in a Patient Admitted for Alcohol Withdrawal. Hospital Physician May 2008
6. Essentials of Clinical Neurology: Neurological Complications of Systemic Disease. Chapter 22
7. www.uptodate.com