Alcoholic and Non-Alcoholic Marchiafava-Bignami Disease: A Comparative Study

Purpose: Marchiafava-Bignami Disease (MBD) is a rare condition mainly associated with alcoholism, although a few non-alcoholic cases have been reported. We performed a comparative study of demographic and clinical differences between alcoholic and non-alcoholic and assessed whether any treatment can be recommended. Methods: We reviewed 157 reports containing data on 168 subjects with Alcoholic MBD (AMBD) and 23 subjects with Non-Alcoholic MBD (NAMBD). The following data were extracted: demographic characteristics; delay from the onset of symptoms to admission; MRI features; location of the corpus callosum lesions; the presence of Wernicke’s disease; drug treatment (thiamine, other vitamins and steroids); outcome. Results: The subjects with AMBD were more frequently men (84.5% vs 47.8, P = 0.000); the ones with AMBD were frequently reported as suffering from malnutrition (81.3% vs 50%, P = 0.019), whereas the NAMBD was frequently reported as suffering from diabetes mellitus (30.4% vs 7.1%, P = 0.002). The lesions in the NAMBD are often located in the splenium (47.8%), whereas single splenial lesions are seen only in 18.7% of the AMBD. 43.5% (10/23) of the NAMBD was reported to have recovered completely, whereas only 15.4% (24/156) AMBD showed a complete recovery. Conclusions: It is important to diagnose NAMBD in the early stage with MRI and to treat the symptoms with thiamine and/or corticosteroids according to aetiology. We recommend prompt treatment of MBD with parenteral thiamine in subjects associated with malnutrition, anorexia nervosa and prolonged vomiting, and reduction of food intake. Corticosteroids may aid in recovery by reducing oedema in subjects associated with diabetes mellitus.