BMJ 1994;308:1663-1667 (25 June)

Papers

Moderate alcohol consumption and loss of cerebellar Prikinje cells

P J Karhune, n, Department of Public Health, University of Tampere, PL 607, SF-33101 Tampere, Finland.,a T Erkinjuntti, P Laippala 

a Department of Public Health, University of Tampere, and Department of Forensic Medicine, University of Helsinki, Finland Department of Neurology, Memory Research Unit, University of Helsinki, Finland Department of Public Health, Biometry Unit, University of Tampere, Finland Correspondence to: Dr

Abstract

Objective : To examine the dose-response effect of alcohol consumption on the number of cerebellar Purkinje cells.
Design : A prospective necropsy study combined with detailed reports on use of alcohol from a relative or friend. The number of Purkinje cells was counted in the anterior midsagittal section of the cerebellar vermis, the area of which was measured by computer assisted morphometry.
Setting : Department of forensic medicine, University of Helsinki.
Subjects : 66 men, aged 35 to 69 years, subjected to medicolegal necropsy because of sudden or violent death. The average all year daily alcohol consumption over the year was 0 to 10 g in 17 men, 11 to 80 g in 24 men, and more than 80 g in 25 men.
Main outcome measures : Number of Purkinje cells, alcohol consumption.
Results : The number of density of Purkinje cells in the cross section of vermis showed a consistent but weak decrease with increasing daily alcohol intake but not with age. A wide variation in the cell counts was observed, especially in men drinking more than 80 g, suggesting differences in the susceptibility to effects of alcohol. Compared with men drinking 40 g or less, a long term moderate consumption of an average of 41 to 80 g daily was associated with a significant average loss of 242 (95% confidence interval 45 to 439) Purkinje cells (15.2%) from a mean of 1583 to 1341 cells. In those drinking 81 to 180 g the average loss was 535 (259 to20811) cells (33.4%) to a mean of 1048 cells. The density of cells in the cross section of vermis also fell significantly by 0.9 cell/mm (0.1 to 1.7) when the daily consumption exceeded 40 g and by 1.4 cell/mm (0.3 to 2.5) when the intake was 81 to 180 g. Only three cases (4.5%) in the series showed macroscopical cerebellar atrophy.
Conclusion : Long term intake of moderate doses of alcohol daily for 20- 30 years may damage the cerebellum before the onset of macroscopical atrophy. Despite distinct individual differences an all year average daily alcohol intake of 41-80 g results in a risk of significant loss of Purkinje cells.

Clinical implications

  • Clinical implications

  • Cerebellar atrophy is an important neurological manifestation of alcohol abuse

  • Attempts have been made to set "safe" limits for alcohol consumption

  • In a necropsy study loss of Purkinje cells was related to long term moderate daily intake of alcohol (41-80 g)

  • Cell loss was greater in subjects who drank 81-180 g daily, but when consumption exceeded 180 g no further decrease in cell numbers was seen

  • Long term moderate drinking may have detrimental effects on tasks such as driving that require proper cerebellar function


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