Abstracts

Rationale: Convulsive seizures and an unconsciousness state frequently manifest as withdrawal syndrome, when alcohol- and substance-dependent patients cease drinking or taking drug abruptly. However some patients have seizures or unconscious state with causes unrelated to alcohol or drug withdrawal. We investigated the causes of seizures and unconsciousness state in 23 inpatients in the alcohol dependence treatment ward of a psychiatric hospital from January 2005 to May 2007.Methods: 23 patients (20 males; 3 females) were included in the study. The clinical records of these patients were reviewed retrospectively for information of alcohol and drug history as well as diagnosis of withdrawal seizure or other clinical states according to DSM-IV and ICD-10. Blood and urine tests, electroencephalograms (EEG), as well as radiological imaging such as CT, MRI, SPECT were conducted in all cases. Results: Clinical symptoms: Generalized tonic clonic seizure (GTC) was observed in 18 of 23 patients (78.2 %). Of 18 patients, 2 developed status epilepticus, 2 had complex partial seizure (CPS), and 1 had secondary GTC. One of 23 patients (4.3% of all cases) had myoclonus. An unconsciousness state was observed in 2 patients (8.6%). Other symptoms suspected to be related to epilepsy were observed in 2 patients (8.6%). Clinical diagnosis: Withdrawal seizure was diagnosed in 14of 23 cases (56.5%), however withdrawal seizure appeared one week after cessation of drinking in 1 case. Epilepsy was diagnosed in 5 of 23 cases (21.7%), and pseudo seizure in the remaining 4 cases (17.4%). Complications (including multiple responses): Somatic disorders comprised alcoholic liver injury in 3 cases, as well as alcoholic liver cirrhosis, hepatitis C, diabetes mellitus, and malignant rheumatoid arthritis in 1 case each. Neuropsychiatric disorders consisted of epilepsy in 5 cases (in which 3 cases was post-traumatic epilepsy), as well as sequela of herpes encephalitis, frontotemporal dementia, mental retardation, schizophrenia, factitious disorder and personality disorder in 1 case each. Conclusions: 1. Post-ictal twilight state should be considered as a differential diagnosis of pathological and complex drunkenness state in alcohol-dependent patients. 2. While the majority of withdrawal seizures are GTCs, CPSs were also observed in 2 patients. 3. Pseudo seizures were observed only in patients with psychiatric complications (frontotemporal dementia, mental retardation, schizophrenia, and factitious disorder).