Peter R. Martin: Historical Vocabulary of Addiction.

Wernicke-Korsakoff Syndrome

Peter Martin’s reply to Hector Warnes’ comment

       I greatly appreciate Hector Warnes’ comprehensive comment concerning my essay on Wernicke-Korsakoff’s syndrome (WKS) which is a chapter in my Historical Vocabulary of Addiction.  It is always gratifying when someone with Hector Warnes’ detailed understanding of the history of Psychiatry concurs with what one has written.  Accordingly, my response will be appropriately brief as we are in agreement on the majority of Warnes’ comments. 

       I would like to correct Warnes’ point that “multiple [nutritional] deficiencies were involved particularly pyridoxine and pantothenic acid” in pathogenesis of WKS.  This is an important point, the sine qua non for the neuropathological findings of WKS is thiamine deficiency, often but not always, enhanced by the metabolic effects of chronic alcohol consumption (De Wardener and Lennox 1947; Martin, Singleton and Hiller-Sturmhöfel  2003; Victor, Adams and Collins  1971).  Accordingly, the following statement by Warnes is probably incorrect: “It was also found that although different etiological factors caused the same illness mostly Korsakoff's psychosis was due to chronic alcoholism.”

       I was not familiar with the term “pseudo-reminiscence” that Warnes employed for denoting the more commonly used confabulation, but admit I like the sound of the word and may start using it to be less monotonous in my writing.

       Warnes rightly mentions Marchiafava-Bignami disease, which is likely a variant of WKS “with finding at necropsy of necrosis and demyelination of the corpus callosum and axonal degeneration” which can be due to alcoholism but also nonalcoholic causes.  However, both require thiamine treatment as recommended by colleagues in Norway, where preferences for the source of alcohol tends to beer, vodka or Akvavit, quite different from that in Italy (Hillbom Saloheimo, Fujioka et al. 2014).

       Finally, I would like to strongly concur with Warnes about the importance of the volume published by Victor, Adams and Collins (1971) which played an immense role in inspiring my own research on the role of thiamine deficiency in brain injury in alcoholics.

References:

De Wardener HE, Lennox B. Cerebral beriberi (Wernicke’s encephalopathy): Review of 52 cases in a Singapore prisoner-of-war hospital. The Lancet 1947;249(6436):11–17. 

Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: A review of CT/MRI confirmed cases. Journal of Neurology, Neurosurgery, and Psychiatry 2014);85(2):168–73.  

Martin PR, Singleton CK, Hiller-Sturmhöfel S. The role of thiamine deficiency in alcoholic brain disease. Alcohol Research & Health 2003;27(2):134–42.

Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff Syndrome: A Clinical and Pathological Study of 245 Patients, 82 with Post-mortem Examinations. Contemp Neurol Ser 1971;7:1-206.

October 7, 2021