Acute Polyneuritis Associated with Edema

A recent revival of beriberi neuropathy in Japan

Abstract

Acute polyneuritis associated with severe edema and often with cardiac enlargement has occurred with increasing frequency in the last few years in Japan. Its pathogenesis has been studied from the viewpoint of vitamin B₁ deficiency. From 1963 to April 1975, 30 patients were detected in Shimane and Tottori Prefectures (3 in 1973, 6 in 1974, 18 in 1975, 3 until April 1975). The blood thiamine content decreased slightly in some cases and the urinary excretionof vitamin B1 showed a marked depression in 3 of 4 cases, examined. Increase of vitamin B₁ excretion in the urine after administration of 5mg of vitamin B₁ was small. Blood lactic and pyruvic acid levels were often elevated. Vitamin B₁ had a specific effect to the disease. Survey of their meals in 19 cases proved that all had been taking completely milled rice. They often took "instant noodles" and soft drinks, containing large amount of sugar, and did not like meat, fish or milk. The nutritional analysis of their meals revealed a high carbohydrate and low vitamin B₁ content. Their age and sex distributions revealed that most patients were young males. Consequently the disorder in problem had to be beriberi neuropathy, which had been extremely scarce until several years ago in Japan. The problems are that its incidence has risen in the last few years and that ordinary Japanese diet has possibly become inadequate, together with the increase in "instant or process food " and milled rice without supplementary B₁. The peripheral nerves uniformly showed the axonal degenerations with unusual findings in the early phase ; irregular accumulation of neurotubulus, and flattened sacs and tubular structures, within the axons. Conduction velocities of the peripheral nerves were normal or slightly reduced.