NUTRITIONAL DISORDERS OF

NERVOUS SYSTEM

BY
DR.SANJAY S. VARADE
M.D. D.M. (NEURO)

SOPAN HOSPITAL & NEUROLOGY INSTITUTE

 Nutrients
proteins, carbohydrates, fats, vitamins, and
minerals provided by food and necessary for
growth and the maintenance of life
 Nervous system
an organ system that coordinates the activities of
muscles, monitors organs, constructs and
processes data received from the senses, and
initiates actions
 Nutrients are needed by nervous system such as
oil needed by car engine
 CAUSES OF NUTRITIONAL
DEFFICIENCIES

1) INADEQUATE DIETARY INTAKE -DUE TO

a) Inadequate access to vitamins and minerals
b) Alcoholism ,Eating disorders like anorexia
nervosa or severely restricted dietary intake
2) IMPAIRED ABSORPTION – DUE TO
a) Intrinsic or iatrogenic gastrointestinal
disorders
b) Bowel Diseases – Inflammatory bowel
disease, coeliac disease
c) Bariatric surgery
 Nerve Nutrients

Nutrients needed by nerves to maintain its activity

and function

Nerve nutrients

Vitamins Minerals Others

• B complex • Calcium • Copper
• Vit E • Magnesium • Iron
• Vit A • Potassium
• Vit D
 VITAMIN B-12 (COBALAMIN)
DEFFICIENCY
SOURCES - ANIMAL PRODUCTS
MECHANISM OF ABSORPTION
DIETARY
RELEASE OF VITAMIN
PROTEIN GASTRIC ACID
FROM
INTAKE
PROTEINS

ENTERS TERMINAL
FREE VITAMIN B-12
 CAUSES FOR
DEFFICIENCY
a) ATROPHIC GASTRITIS LOSS OF INTRINSIC FACTOR

b) JEJUNAL DIVERTICULOSIS COELIAC DISEASE,

BARIATRIC SURGERY

C) DRUG INDUCED – PPI, H2 BLOCKERS (LONG TERM USE)

ACHLORHYDRIA
CHRONIC EXPOSURE TO NITROUS OXIDE ,
LONG TERM USE OF METFORMIN WHICH INTERFERES
WITH Ca DEPENDENT
ILEAL MEMBRANE FUNCTION
 METHYLMALONYL VITAMIN
SUCCINYL
CO A B-12
CO A

VITAMIN B-12
DEFFICIENCY

METHYLMALONIC (CAUSES
MYELIN DAMAGE)
PATHOLOGY

a) SPINAL CORD Demyelination in posterior

and
lateral column
b) BRAIN FRONTAL WHITE MATTER

C) OPTIC NERVE AND PERIPHERAL NERVES

D) HAEMATOLOGIC EFFECTS
PERNICIOUS ANEMIA
CLINICAL FEATURES
a) NEUROLOGICAL – MYELONEUROPATHY

Spastic ataxic gait,

burning painful
hands & feet
MEMORY LOSS, VISUAL LOSS, ANOSMIA,
IMPARED
TASTE SENSATION, ORTHOSTATIC
HYPOTENSION
RARELY – SPHINCTER SYMPTOMS AND
IMPOTENCE
DIAGNOSIS AND
TREATMENT
a) Serum Vitamin B-12 Level
b) Serum Homocystine Level
c) MCV
d) MRI BRAIN / SPINE ( HYPERINTENSE SIGNAL IN
POSTERIOR LATERAL COLUMN AND FRONTAL
LOBE WHITE MATTER )

TREATMENT :- INJ CYANOCOBALAMIN

1000 mg daily x 1 week
THEN
MONTHLY FOR LIFE
+
VITAMIN B1 (THIAMINE)
DEFFICIENCY
PLAYS IMPORTANT ROLE IN METABOLISM OF AMINO
ACID
AND CARBOHYDRATES & ACETYLCHOLINE
PRODUCTION
RESPONSIBLE FOR NMJ TRANSMISSION AND
NEUROTRANSMISSION
MAINTAINING PROPER MUSCLE TONE IN HEART
AND
GI-TRACT

DEFFICIENCY CAN RESULT IN COMPROMISED

HEART
FUNCTION AND GI FUNCTION , MUSCLE TENDERNESS
 CLINICAL FEATURES
a) WERNICKNES KORSAKOFF SYNDROME
THIAMINE PYROPHOSPHATE IS NECESSARY FOR
ATP FORMATION AND DEFICIENCY LEADS TO
ENERGY FAILURE.
SITES OF INVOLMENT SYMMETRICAL LESIONS IN
PERIVENTRICULAR REGION OF THALAMUS,
HYPOTHALAMUS, MAMMILLARY BODIES AND
PERIAQUEDUCTAL REGION OF MIDBRAIN, FLOOR
OF 4TH VENTRICLE IN THE REGION OF DORSAL
MOTOR NUCLEUS OF VAGUS & VESTIBULAR
NUCEI, SUPERIOR CEREBELLAR VERMIS.

TRIAD :- OPHTHALMOPLEGIA, ATAXIA AND

BERIBERI
INFANTILE BERI BERI :- INFANTS ON FORMULA FEED
PRIMARILY
CARDIOPULMONARY PICTURES
NEUROLOGIC SYNDROMES VOMITING, NYSTAGMUS
AND SEIZURES ADULT BERI BERI
DRY - SUBACUTE SENSORIMOTOR NEUROPATHY
WET - HIGH OUTPUT CARDIAC FAILURE SOMETIMES
WITH NEUROPATHY
DIAGNOSIS AND TREATMENT
MAINLY ON CLINICAL GROUNDS WITH BLOOD THIAMINE
LEVEL AND MRI
BRAIN
TREATMENT WKS - MEDICAL EMERGENCY -
SUSPICIOUS
IV / IM INJ. THIAMINE 100.mg DAILY X 7-14 DAYS
FOLIC ACID ( VIT B 9 )
DEFFICIENCY

SOURCES :- VEGETABLES, LEGUMES AND

ANIMAL PRODUCTS

CAUSES :- DIETARY DEFFICIENCY,

MALABSORPTION
SYNDROME, PREGNANCY AND LACTATION
DRUG INDUCED :- ANTICANCER,
ANTIEPILEPTICS
AND ORAL CONTRACEPTIVES
ALCOHOLISM
CLINICAL FEATURES :- MAINLY
PYRIDOXINE DEFFICIENCY
(VIT B6)
HAVING IMORTANT ROLE IN METABOLISM OF AMINO
ACIDS, LIPIDS AND CARBOHYDRATES ALSO PLAYS
ROLE IN NEUROTRANSMITTER FORMATION,
ENDOCRINE FUNCTION, HUMORAL AND CELL
MEDIATED IMMUNITY.
CAUSES :- MALNUTRITION, MALABSORPTION
UREMIA & DIALYSIS
ISONICOTINIC ACID, HYDRALAZINE
CLINICAL FEATURES :- PERIPHERAL NEUROPATHY &
SEIZURES.

(EXCESS PYRIDOXINE :- SENSORY NERUROPATHY )

NICOTINIC ACID (VIT.B3)
DEFFICIENCY

CAUSES :- MAIZE EATING PEOPLES,

ALCOHOLICS

CLINICAL FEATURES :- PELLAGRA-

AFFECTS SKIN AND
GI-TRACT,
NERVOUS SYSTEM

(DDD)
PANTOTHENIC ACID (VIT B5)
DEFFICIENCY)

SENSORY NEUROPATHY
BURNING FOOT
RIBOFLAVIN (VIT.B2)
DEFFICIENCY

GLOSSITIS, CHEILOSIS AND

NEUROPATHY

TREATMENT :- ORAL RIBOFLAVIN

500mg/day
& CARNITINE 4mg per day
( Till symptoms relieves)
BIOTIN (VIT B8)
DEFFICIENCY
DEFFICIENCY CAUSES DISORDERED ACTIVITY OF
PYROVATE CARBOXYLASE ENZYME (WHICH IS
BIOTIN DEPENDENT) LEADING
TO ACCUMULATION OF PYRUVATE B AND WITH
DEPLETION OF ASPERTATE WHICH RESULTS IN
AFFECTION OF NERVOUS SYSTEM METABOLISM.

HIV RELATED NEUROPATHY & DIABETIC

NEUROPATHY WITH AUTONOMIC NEUROPATHY ARE
TREATED WITH BIOTIN FOR 4
WEEKS THERAPY.
VITAMIN E DEFFICIENCY

FAT SOLUBLE VITAMIN, AVAILABLE IN MEAT ,

EGGS & VEGETABLES
COMPONENT OF CELL MEMBRANE AND
ACTS AS ANTIOXIDANT
DEFFICIENCY IS DUE TO IMPAIRED FAT
ABSORPTION & MALABSORPTION IN CHRONIC
CHOLESTATIC & HEPATOBILIARY DISEASE
DEFFICIENCY RESULTS IN
NEUROPATHY, MYOPATHY,
SPINO CEREBELLAR ATAXIA, HEAD
VITAMIN A DEFFICIENCY
(RETINOL)
FAT SOLUBLE VITAMIN FOUND IN PLANTS,
FISH, DAIRY & MEAT
HAVING CRITICAL ROLE IN FOETAL EYE
DEVELOPMENT AND MAINTENANCE OF
FOETAL PHOTORECEPTOR CELLS.

CLINICAL FEATURES :- XEROPHTHALMIA

(VITAMIN A TOXICITY INCREASED
CSF
VITAMIN D DEFFICIENCY
FAT SOLUBLE VITAMIN

SOURCES :- DIET, SUNLIGHT EXPOSURE

PLAYS A ROLE :- IN BONE DEVELOPMENT AND
MAINTENANCE OF
CELLULAR FUNCTION
AND IMMUNE SYSTEM.
CLINICAL FEATURES :- RICKETS IN CHILDREN

OSTEOMALACEA & MYOPATHY IN

ADULTS.
DIAGNOSIS :- SERUM 25-HYDROXY VITAMIN D
LEVEL
 COPPER DEFFICIENCY (TRACE
MINERALS)
CAUSES :- 1) ENTERAL FEEDING
2) GASTROSTOMY
3) USE OF COPPER CHELTING AGENT
4) EXCESSIVE ZINC ADMINISTRATION (As Zinc
competes for Copper
for intestinal absorption)
5) ZINC CONTAINING DENTAL CREAMS

ABSORPTION STOMACH & PROXIMAL

LIVER
SMALL INTESTINE
(Copper becomes
part of
CLINICAL FEATURES :-(Changes seen over skin,
hair, liver, bone
& nervous system)
MYELOPATHY &
MYELONEUROPATHY
(Seen as prominent loss of
vibration & joint position
sense with hyperreflexia and
extensor plantars.)
LAB :- 1) SERUM COPPER AND SERUM
CERULOPLASMIN
2) SERUM ZINC AND 24 HOURS
OTHER MINERAL
DEFFICIENCIES
A) IRON :- CHILDREN DEVELOPMENTAL
DELAY
ADULTS RESTLESS LEG
SYNDROME
B) CALCIUM MUSCLE CRAMPS, WEAKNESS &
SEIZURES
(HELPS IN KEEPING NERVES
HEALTHY & ENSURES THEIR ABILITY TO
COMMUNICATE EFFECTIVELY)
C) MAGNESIUM MUSCLE CRAMPS,
WEAKNESS & SEIZURES
(AFFECTS BONES, NERVES,
MUSCLE AND
POTASSIUM
* MAINTAINS BODY WATER BALANCE
* CATALYST FOR ENZYMES INVOLVED IN
ENERGY METABOLISM
* STABILIZES BODY CELL STRUCTURE,
PROTEIN SYNTHESIS
* CONTROLS NERVE IMPULSE
TRANSMISSION AND ACID/
ALKALI/ BALANCE
SOURCES :- DRY FRUITS,SOYS FLOUR,
RAW SALAD &
VEGETABLES , CHIPS, NUTS,
FRESH FRUITS,
 Conclusion
 Deficiency of nutrients could lead to many
nerve related diseases.

 The only way to treat the nerve damaged that are

caused by nutrients, is to take the correct nutrients;
vitamins and minerals in adequate amount.