Seizures
Lauren A. Plante in Expecting Trouble, 2018
Additional evaluation may include lumbar puncture, blood work, and urine toxicology, but there is insufficient evidence to recommend these tests routinely (30,31). Lumbar puncture may be helpful in specific situations, such as when the presentation includes fever or in an immunocompromised patient (27,35). An abnormal white blood cell count is not uncommon (29% of new-onset seizures and 4% of recurrent seizures) but rarely alters management (36). In general, the yield of blood work is lower in patients whose symptoms have resolved. Normal physiological changes in laboratory values that occur during pregnancy should be considered when in interpreting blood work results. Seizures have been reported due to intoxication with selective serotonin reuptake inhibitors, cocaine, and other stimulants; toxicology rarely alters management but has implications for neonatal care and management. Alcohol-related and alcohol withdrawal seizures are a diagnosis of exclusion.
Causes of epilepsy
Timothy Betts, Lyn Greenhill in Managing Epilepsy with Women in Mind, 2005
Epilepsy may rarely be the result of intoxication with lead and other heavy metals; the commonest toxins, however, are alcohol and drugs. Acute intoxication with alcohol can cause seizures as can acute withdrawal of alcohol in people who are habituated to it (tonic-clonic seizures occur in 50% of patients with delirium tremens). People with chronic alcoholism can sometimes develop epileptic seizures, independent of intoxication or withdrawal, presumably as the result of brain damage caused by alcohol or because of brain injury sustained from falls. Seizures are very difficult to control unless the patient can abstain. Complex vitamin and mineral deficiencies and overhydration may also play a part in the epilepsies associated with alcohol. Except in obvious intoxication or withdrawal seizures, it is good clinical practice to investigate epilepsy occurring in someone with a history of alcoholism as carefully as one would with any other patient and not just ascribe the seizures to 'rum fits'. Social drinking has no effect on seizure frequency, except in rare exceptional patients, and should not be discouraged. Many waking seizures ascribed to alcoholic indulgence the night before are, in fact, due to associated sleep deprivation and not the alcohol.
Substance Use: Our Patients, Drugs and Alcohol
James Matheson, John Patterson, Laura Neilson in Tackling Causes and Consequences of Health Inequalities, 2020
Alcohol withdrawal syndrome is associated with a 5–15% risk of death [32]. Alcohol withdrawal may precipitate delirium tremens, seizures may follow and death may occur from cardiac arrhythmias and respiratory failure [33]. These risks can be reduced through pharmacologically supported detox [33], but risks increase with multiple attempts to detox especially when in close succession, in a process called ‘kindling’ [34].Chris didn’t get a Librium prescription that day or for some time later. After several detoxes when he had presented with withdrawal symptoms at A&E, Chris eventually followed up on our referral to local services and engaged with counselling and a support group. He had a supervised detox in the community, seeing a support worker on alternate days. A year on from this he still hasn’t had a drink. ‘At first I didn’t want to stop drinking’, says Chris. ‘I was only doing it because other people said I had to. Once I realised I needed to do it for me, I found the motivation to push through it and I feel so much better now. My life is coming back together’. Chris is now off his thiamine but stays on Acamprosate and attends regular meeting of Alcoholics Anonymous. ‘I still think about booze a lot and the idea of never drinking again is still terrifying. That’s why I’ve promised myself a drink on my 80th birthday’, he says laughing.
A Pilot Randomized, Placebo-Controlled Trial of Glycine for Treatment of Schizophrenia and Alcohol Dependence
Published in Journal of Dual Diagnosis, 2019
Jane Serrita, Elizabeth Ralevski, Gihyun Yoon, Ismene Petrakis
Participants were excluded from the study if (a) they met current criteria for substance dependence (other than alcohol and nicotine) and major anxiety disorders (obsessive-compulsive disorder, posttraumatic stress disorder) to avoid confounding of anti-anxiety medication, (b) there was evidence of significant hepatocellular injury (abnormal SGOT or SGPT levels more than five times normal), (c) they had a history of seizures (including alcohol withdrawal seizures), (d) they had neurological disorders of the central nervous system, (e) they had diabetes, (f) they were taking clozapine or medications to treat alcohol dependence or withdrawal (e.g., naltrexone or disulfiram), or (g) they presented with medical conditions that would alter glycine metabolism or response. Other anxiety disorders were allowed, as was major depression as part of the schizoaffective disorder.
Substance use disorders: diagnosis and management for hospitalists
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ahmed K. Pasha, Arnab Chowdhury, Sanah Sadiq, Jeremiah Fairbanks, Shirshendu Sinha
Patients with alcohol withdrawal should be assessed periodically by the Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) protocol [15]. In most of the hospitals, this protocol is nursing driven. Benzodiazepines are the first-line agent for withdrawal symptoms [10]. They significantly reduce the risk of seizure within first 2 days. Benzodiazepines are either used as symptom triggered therapy (STT) or fixed scheduled doses (FSD). In STT, benzodiazepine medications are administered per symptom-based CIWA-Ar protocol. This can not be used for non-verbal patients. Also, this approach is not considered safe for patients with history of alcohol withdrawal seizures. In FSD, the benzodiazepine is administered at scheduled intervals regardless of symptoms and then tapered. Both approaches are equally effective [16]. Various FDS dosing protocols exist.
Clinical consequences related to a defective elimination of clobazam caused by homozygous mutated CYP2C19 allele
Published in Clinical Toxicology, 2019
David Boels, Stéphanie Chhun, Géraldine Meyer, Bénédicte Lelièvre, Vincent Souday
Benzodiazepines are widely prescribed all over the world [1]. They are used for the treatment of severe or incapacitating manifestations of anxiety, delirium tremens and other instances of alcohol withdrawal, and for generalized or partial epilepsy. Side effects are dose-dependent and related to the patient’s sensitivity. If too much is taken, they may cause anterograde amnesia, behavioral problems, alteration of consciousness (confusion, drowsiness), headaches or hypotonia. Voluntary drug intoxications with benzodiazepines are frequent and generally have a favorable prognosis. In the case of overdoses with severe clinical consequences (hypotonia, ataxia, coma, hypotension, and respiratory distress), flumazenil can be used with care (possibility of convulsions particularly in epileptic patients) to avoid tracheal intubation for respiratory protection.
Related Knowledge Centers
- Alcohol Withdrawal Syndrome
- Cocaine
- Delirium
- Hallucination
- Palpitations
- Tremor
- Hyperthermia
- Seizure
- Benzodiazepine Withdrawal Syndrome
- Barbiturate