Withdrawal seizures

Introduction Withdrawal seizures, also known as "rum attacks", are common symptoms during alcohol withdrawal (relative or absolute alcohol ban after long-term chronic alcoholism). More than 90% of withdrawal episodes occur 7 to 48 hours after stopping drinking, and 13 to 14 hours is the peak time. During the convulsion activity period, the EEG is abnormal, but it can be recovered after a few days. Can be expressed as a one-time episode, but most cases are sudden 2 to 6 episodes, sometimes more. 2% of patients develop into epilepticus and most of them are major episodes. Local seizures suggest local presence (mostly trauma) in addition to alcohol. About 30% of patients with systemic withdrawal convulsions develop into a state of tremor, which is a prodromal symptom of convulsions.

Cause

(1) Causes of the disease

Alcoholics with physical dependence, in the process of abstinence, the central nervous system loses the inhibition of alcohol, resulting in excessive excitation of the cerebral cortex and/or -adrenergic nerves.

(two) pathogenesis

1. Alcoholic tremulousness The pathogenesis is thought to be caused by excessive excitability of -adrenergic receptors in the central and peripheral nerves after alcohol withdrawal. That is, due to sympathetic excitation, the increase in catecholamines in the blood increases the rate of skeletal muscle contraction, thereby interfering with neuromuscular conduction or muscle spindle activity, resulting in increased tremor intensity in these patients.

2. Alcoholic withdrawal seizure The pathogenesis is unclear. It has been suggested that various pathogenesis, including hypomagnesemia, carbonemia and various other metabolic disorders, can occur during epileptic activity. However, these mechanisms have not been confirmed, and measures such as supplementation with magnesium ions cannot prevent their onset.

3. Deterium tremens (DT) is an acute encephalopathy syndrome based on chronic alcoholism. It can be caused by trauma, infection and other factors that weaken the body's resistance.

an examination

Related inspection

Electroencephalography CT examination

1. Occasionally, blood sugar is significantly reduced under alcohol withdrawal; normal blood sugar ketoacidosis can also occur.

2. The incidence and degree of electrolyte imbalance vary, and changes in blood sodium are uncommon. If there is a change, the increase is more common than the decrease. Blood chlorine and blood phosphorus also have the same changes, and about a quarter of patients have lower serum calcium and potassium. Most patients have a certain degree of hypomagnesemia, low carbon dioxide partial pressure and elevated arterial pH.

3. Regular lumbar puncture examination is very meaningful for the identification of acute alcohol withdrawal syndrome, especially tremor.

4. EEG examination of brain wave frequency decreased during chronic alcoholism, EEG can quickly return to normal after stopping drinking; transient arrhythmia (spine wave and paroxysmal discharge) consistent with convulsion activity also quickly returned to normal . In addition to short-term sexual loss during abstinence, the abnormal rate of EEG in patients with rum seizures is not higher than that of normal people, and in patients with non-alcoholic seizures, the abnormal rate of EEG is much higher.

5. Brain, chest X-ray and CT scan are useful for differential diagnosis.

Differential diagnosis

1. Pay attention to the identification of other toxic encephalopathy.

2. Special attention should be paid to certain primary epilepsy or traumatic epilepsy, etc. may also be induced by drinking, and should be carefully diagnosed before diagnosis. Systemic episodes with focal manifestations, or focal seizures, such as psychomotor or complex partial epilepsy, focal motor epilepsy, etc., may not be alcoholic epilepsy. EEG examination helps identify.

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