The etiology of ALN has been debated for nearly a century. ALN is rarely discussed as a specific disease entity in textbooks because it is widely assumed to primarily reflect consequences of nutritional deficiency, specifically thiamine. Recent clinical trials have failed to show reversal of the disease with thiamine treatment. We propose that ALN is the result of a multi-factorial process primarily mediated by the toxic effect of alcohol modulated by other factors such as genetic predisposition, thiamine deficiency, altered thiamine metabolism, malnutrition and systemic diseases

Michelle Mellion, MD, James M. Gilchrist, MD, and Suzanne De La Monte, MD