Pellagra and spinal myoclonus

 

Park K, Oeda T, Sawada H. A case of alcoholic pellegra encephalopathy presenting with spinal myoclonus.  Neurology Clinical Practice 5; 472-3.

 

The authors present a case of alcoholic pellagra  with confusion and myoclonus responding dramatically to administration of niacin1500 mg per day starting 16 days after admission.  Essential points include:

 

1. Pellagra is rare in US but not in alcoholics

2. Dermatitis may be subtle and not appreciated

3.  Thiamine and niacin levels may be normal

4.  Thiamine may cause worsening due to increased demand for niacin

5.  Myoclonus in context is important to diagnosis, often stimulus sensitive

6.  Severe sensory ataxia, incontinence and dysautonomia also occur and improve with treatment

 

the 4 D's of pellagra, again, are , diarrhea, dementia, dermatitis and death