Withdrawal attack

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A withdrawal attack ( English withdrawal seizure ) is an epileptic occasion seizure , as a complication of a withdrawal syndrome when alcohol dependence to rapid reduction of the dose of or an anticonvulsants such as benzodiazepines may occur (after a long, regular use). Before diagnosing a withdrawal attack, hypoglycemia , a previous traumatic brain injury , previously unknown structural damage to the brain or a (rare) causative infection must be ruled out. Since patients with a dependency have a large number of concomitant diseases and can often only provide insufficient information about their previous history, a comprehensive clarification must be arranged. In the case of a single episode of withdrawal, no antiepileptic drugs are necessary because of the favorable further course . It is important to distinguish between occasional seizures of other causes, especially for assessing whether they are still fit to drive or participate in road traffic.

alcohol

Two percent of the population have epilepsy , and approximately 5% of the population (including those who have had casual seizures) will have cerebral seizures at some point in their life. The withdrawal attack of alcoholics is one of the most common causes. A withdrawal attack occurs in up to a third of patients with pronounced alcohol withdrawal syndrome.

Conversely, 41% of patients admitted to hospital with seizures had alcohol consumption that was assessed as problematic, mainly men between the ages of 40 and 50 and 59% of these with alcohol withdrawal syndrome. Focal seizures were observed in 24% of the alcohol group .

These are mostly generalized, tonic-clonic seizures without aura and with a brief, postictal twilight state . They occur as a single episode or in a short series of up to three seizures 24 hours after the last drink. Delirium tremens develops in 30–50% . Most seizures are short-lived or can be easily stopped with benzodiazepine administration. A status epilepticus occurs in 3% of cases and forces a more comprehensive investigation.

Benzodiazepines

Withdrawal seizures are also the most serious complication of withdrawal syndrome in benzodiazepine addiction. Benzodiazepines are effective anti-epileptic drugs, which explains, at least in part, the occurrence of withdrawal attacks when they are suddenly stopped. Withdrawal attacks in benzodiazepine addicts usually do not lead to permanent damage. There are no controlled studies on benzodiazepine withdrawal in patients with concomitant opioid use , as this has always been an exclusion criterion for previous studies; thus no verifiable statements can be made about the complications of benzodiazepine withdrawal in this patient group.

It is recommended to switch to a long-acting benzodiazepine such as diazepam and to discontinue this for a longer period of time. Different recommendations have been made, e.g. B. reduce the original dose every week by 25%. In practice, it is relevant that patients with multi-substance dependence and a history of withdrawal attacks are difficult to motivate to refrain from taking any further benzodiazepines.

Withdrawal attacks have also been described in cases of zolpidem dependence. However, if you are dependent on zolpidem, you can choose a standard withdrawal procedure with diazepam.

GHB

4-Hydroxybutanoic acid (GHB) is an independent neurotransmitter in the human body that has been increasingly used as a party drug (liquid ecstasy) since the late 1990s. Seizures rarely occur even after GHB withdrawal syndrome. Even if various examiners see more myoclonia (rapid involuntary muscle twitching) here, the administration of anticonvulsants is indicated in acute treatment. Baclofen was administered successfully in one study .

Individual evidence

  1. ↑ a b c Withdrawal syndromes . Medscape
  2. ↑ MP. Earnest: Seizures . In: Neurol Clin. , 1993 Aug, 11 (3), pp. 563-575, PMID 8377743 .
  3. ^ MP Earnest, PR. Yarnell: Seizure admissions to a city hospital: the role of alcohol . In: Epilepsia , 1976 Dec, 17 (4), pp. 387-393, doi: 10.1111 / j.1528-1157.1976.tb04450.x .
  4. ↑ Benzodiazepine withdrawal symptoms, acute & protracted . In: The Ashton Manual , Chapter III
  5. ↑ M Fatséas, E Lavie, C Denis, P Franques-Rénéric, J Tignol, M. Auriacombe: Benzodiazepine withdrawal in subjects on opiate substitution treatment . In: Presse Med. 2006 Apr, 35 (4 Pt 1), pp. 599-606, PMID 16614601 (French).
  6. ↑ Nicholas Seivewright, assisted by Mark Parry: Community Treatment of Drug Misuse: More Than Methadone . Cambridge University Press, 2009
  7. ^ M. Aragona: Abuse, dependence, and epileptic seizures after zolpidem withdrawal: review and case report . In: Clin Neuropharmacol . 2000 Sep-Oct, 23 (5), pp. 281-283, PMID 11154097 .
  8. ^ Yi-Wei Yeh et al .: Zolpidem Dependence, Withdrawal Seizure and Comorbidity Following Different Outcomes: Two case Reports and a Review of the Literature . ( Memento of the original from December 5, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 120 kB) In: J Med Sci , 2008, 28 (6), pp. 263–267 @1@ 2Template: Webachiv / IABot / jms.ndmctsgh.edu.tw
  9. ^ LR Rappa, M Larose-Pierre, DR Payne, NE Eraikhuemen, DM Lanes, ML. Kearson: Detoxification from high-dose zolpidem using diazepam . In: Ann Pharmacother . , 2004 Apr, 38 (4), pp. 590-594, Epub 2004 Feb 13, PMID 14966257
  10. ^ K Miotto, B Roth: GHB Withdrawal Syndrome " (PDF; 64 kB) Texas Commission on Alcohol and Drug Abuse, 2001
  11. ↑ JL LeTourneau, DS Hagg, SM. Smith: Baclofen and gamma-hydroxybutyrate withdrawal . In: Neurocrit Care , 2008, 8 (3), pp. 430-433, PMC 2630388 (free full text).