To determine the optimal thiamine dose required for:
- Treatment of acute symptomatic Wernicke-Korsakoff syndrome (WKS) among alcohol-dependent patients
- Reducing or preventing subclinical WKS-related brain damage in ‘at-risk’ alcohol-dependent patients.
- To compare three different dosages of Thiamine for each condition to determine the optimum thiamine dose.
Alcohol misuse is the primary cause of thiamine deficiency in Australia due to poor dietary intake and alcohol’s impact on thiamine absorption and metabolism. Thiamine is a vital nutrient enabling brain cell utilisation of glucose, and deficiency causes brain impairment including WKS. Appropriate, timely replenishment of thiamine is essential for reducing further brain impairment and preventing permanent brain injury (i.e. Korsakoff’s
psychosis/dementia) or even death.
Two multi-dose trials will be conducted to determine the optimum dosing regimen for:
a) the treatment of acute symptomatic Wernicke-Korsakoff Syndrome (WKS)
b) the prevention of subclinical WKS in at-risk alcohol dependent patients.
Study A tests the efficacy of 300mg, 900mg or 1500mg daily for the treatment of symptomatic WKS. Study B tests the efficacy of 100mg, 300mg, or 900mg daily for the prevention of subclinical WKS-related brain damage in at-risk patients. We are aiming to recruit 225 participants per study.
Implications for policy and practice:
The need for evidence-based thiamine treatment protocols is of great clinical importance. First, in relation to acute symptomatic WKS, a failure to treat immediately or adequately may result in profound and often permanent cognitive and neurological disability. Secondly, the need for evidence-based treatment guidelines is greatly magnified when it is recognised that milder, subclinical WKS may be preventable with adequate thiamine treatment.
The results of this study will contribute new knowledge to the scientific literature regarding the optimum dose for the treatment and prevention of WKS in an Indigenous health setting. This evidence, will inform the development of national best practice protocols for alcohol-related thiamine deficiency leading to improved treatment and clinical management for WKS patients.
The project commenced in January 2014 and will conclude in December 2017.
- National Health and Medical Research Council (NHMRC)
- Alice Springs Hospital.