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Ott M, Werneke U. Wernicke's encephalopathy - from basic science to clinical practice. Part 1: Understanding the role of thiamine. Ther Adv Psychopharmacol. 2020;10:2045125320978106doi: 10.1177/2045125320978106.
Ott, M., & Werneke, U. (2020). Wernicke's encephalopathy - from basic science to clinical practice. Part 1: Understanding the role of thiamine. Therapeutic advances in psychopharmacology, 102045125320978106. https://doi.org/10.1177/2045125320978106
Ott, Michael, and Werneke, Ursula. "Wernicke's encephalopathy - from basic science to clinical practice. Part 1: Understanding the role of thiamine." Therapeutic advances in psychopharmacology vol. 10 (2020): 2045125320978106. doi: https://doi.org/10.1177/2045125320978106
Ott M, Werneke U. Wernicke's encephalopathy - from basic science to clinical practice. Part 1: Understanding the role of thiamine. Ther Adv Psychopharmacol. 2020 Dec 29;10:2045125320978106. doi: 10.1177/2045125320978106. eCollection 2020. PMID: 33447357; PMCID: PMC7780320.
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Ther Adv Psychopharmacol. 2020 Dec 29;10:2045125320978106. doi: 10.1177/2045125320978106. eCollection 2020.

Wernicke's encephalopathy - from basic science to clinical practice. Part 1: Understanding the role of thiamine.

Therapeutic advances in psychopharmacology

Michael Ott, Ursula Werneke

Affiliations

  1. Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
  2. Department of Clinical Sciences, Division of Psychiatry, Sunderby Research Unit, Umeå University, Umeå, Sweden.

PMID: 33447357 PMCID: PMC7780320 DOI: 10.1177/2045125320978106

Abstract

Wernicke's encephalopathy (WE) is an acute neuropsychiatric state. Untreated, WE can lead to coma or death, or progress to Korsakoff syndrome (KS) - a dementia characterized by irreversible loss of anterograde memory. Thiamine (vitamin B1) deficiency lies at the heart of this condition. Yet, our understanding of thiamine regarding prophylaxis and treatment of WE remains limited. This may contribute to the current undertreatment of WE in clinical practice. The overall aim of this review is to identify the best strategies for prophylaxis and treatment of WE in regard to (a) dose of thiamine, (b) mode of administration, (c) timing of switch from one mode of administration to another, (d) duration of administration, and (e) use of magnesium along thiamine as an essential cofactor. Evidence from randomized controlled trials and other intervention studies is virtually absent. Therefore, we have to resort to basic science for proof of principle instead. Here, we present the first part of our clinical review, in which we explore the physiology of thiamine and the pathophysiology of thiamine deficiency. We first explore both of these in their historical context. We then review the pharmacodynamics and pharmacokinetics of thiamine, exploring the roles of the six currently known thiamine compounds, their transporters, and target enzymes. We also explore the significance of magnesium as a cofactor in thiamine-facilitated enzymatic reactions and thiamine transport. In the second (forthcoming) part of this review, we will use the findings of the current review to make evidence-based inferences about strategies for prophylaxis and treatment of WE.

© The Author(s), 2020.

Keywords: Korsakoff syndrome; Wernicke encephalopathy; beriberi; magnesium; thiamine; thiamine deficiency; vitamin B1

Conflict of interest statement

Declaration of conflicting interests: Michael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbo

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