alcohol induced seizures

7/31/2019 Alcohol Induced Seizures

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Alcohol Withdrawal Seizures


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SEIZURES

A seizure(from the Latin sacire, to take possession of )is a paroxysmal event due to abnormal, excessive,hypersynchronous discharges from an aggregate ofcentral nervous system (CNS) neurons. Depending on

the distribution of discharges, this abnormal CNS activitycan have various manifestations, ranging from dramaticconvulsive activity to experiential phenomena not readilydiscernible by an observer.

Although a variety of factors influence the incidence and

prevalence of seizures, ~510% of the population willhave at least one seizure, with the highest incidenceoccurring in early childhood and late adulthood.


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Causes of Seizures

Seizures are a result of a shift in the normal balance of excitationand inhibition within the CNS.

Three clinical observations emphasize how a variety of factorsdetermine why certain conditions may cause seizures or epilepsyin a given patient.

1.The normal brain is capable of having a seizure under the appropriatecircumstances, and there are differences between individuals in thesusceptibility or threshold for seizures.

2. There are a variety of conditions that have an extremely high likelihood ofresulting in a chronic seizure disorder.

3. Seizures are episodic.


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BASIS

Past Medical History- alcohol withdrawal siezures- currently takes Phenytoin for seizure

prophylaxis Family and Social History

- alcohol abuse

- enrolled in Alcoholics Anonymous- has not had a drink for > 1 year


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Treatment Objectives

The major objective of drug therapy in thealcohol withdrawal period is prevention ofseizures, delirium and arrhythmias.

Therapy for a patient with a seizure disorderis almost always multimodal.

Includes treatment of underlying conditions that cause orcontribute to the seizures

Avoidance of precipitating factors

Suppression of recurrent seizures by prophylactictherapy with antiepileptic medications


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The first step is to perform a thorough physical examination inall alcoholics who are considering stopping drinking, includinga search for evidence of liver failure, gastrointestinal bleeding,

cardiac arrhythmia,infection, and glucose or electrolyteimbalance.

The second step is to offer reassurance that the acutewithdrawal is short lived and to offer adequate nutrition and

rest. All patients should be given oral multiple B vitamins,including 50100 mg of thiamine daily for a week or more.

The third step in treatment is to recognize that most

withdrawal symptoms are caused by the rapid removal of aCNS depressant, in this case, alcohol. With our case, drugsused for the treatment of seizures.


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Non-Pharmacologic Therapy

The core of treatment begins with helping patientsrecognize the need to change, while working withthem to alter their behaviors to enhance compliance.

The first step is to help the alcoholic achieve and maintain a highlevel of motivation toward abstinence.

The second step is to help the patient readjust to life without alcoholand to reestablish a functional lifestyle through counseling,

vocational rehabilitation, and self-help groups such as AlcoholicsAnonymous (AA).

The third component, called relapse prevention


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Pharmacologic Therapy

CYCLIC

UREIDES

TRICYCLICS BENZODIAZEPINES GABA

DERAVATIVES

EFFICACY

SAFETY

SUITABILITY

COST


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PHENOBARBITAL PHENYTOIN PRIMIDONE

EFFICACY

SAFETY

SUITABILITY

COST


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DOC: PHENYTOIN

Phenytoin is a diphenyl-substituted hydantoin. It has muchlower sedative properties than compounds with alkylsubstituents at the 5 position.

MECHANISM OF ACTION:

Phenytoin has major effects on several physiologicsystems. It alters sodium, potassium and calciumconductance, membrane potentials and theconcentrations of amino acids and the neurotransmittersnorepinephrine, acetylcholine and GABA. It blockssustained high-frequency repetitive firing of actionpotentials


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CLINICAL USE:

Phenytoin is effective against partial seizures and

generalized tonic-clonic seizures. In the latter, it appearsto be effective against attacks that are either primary orsecondary to another seizure type.

CONTRAINDICATIONS:History of hypersensitivity to hydrantoins

DRUG INTERACTION:

Plasma concentrations increased by some antibiotics andother anticonvulsants, simetidine, coumarin,anticoagulant, disulfiram, INH, some phenothiazines,phenylbutazone, sulfinpyrazone; decreased by

carbamazepine, sucralfate


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Steroid-induced Gastritis


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Gastritis

The term gastritis should be reserved for histologicallydocumented inflammation of the gastric mucosa.Gastritis is not the mucosal ery- thema seen duringendoscopy and is not interchangeable with dys- pepsia.The etiologic factors leading to gastritis are broad andheterogeneous. Gastritis has been classified based ontime course (acute vs. chronic), histologic features, andanatomical distribution or proposed pathogenicmechanism.

The correlation between the histologic findings ofgastritis, the clinical picture of abdominal pain ordyspepsia, and endoscopic findings noted on grossinspection of the gastric mucosa is poor. Therefore,

there is no typical clinical manifestation of gastritis.


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CAUSES OF GASTRITIS

There are numerous causes for gastritis and these are listed below:1) Medications like ASA and other non-steroidal anti-inflammatory drugs

(NSAIDS) and steroids- this type of gastritis develops slowly, in otherwisehealthy people, presenting with bleeding or ulcers. Alcohol, caffeine,nicotine can also cause gastritis.

2) Stress due to severe illness- this is the most severe type of gastritis. Thismay occur e.g. after a severe burn and injuries.

3) Bacterial infection- commonly results from an infection by Helicobacterpylori ( bacteria that grow in the mucus secreting cells of the stomach

lining). No other bacteria are known to grow in the normally acidic stomach,but many types of bacteria may grow if the stomach does not produce acid.

4) 4) Viral or fungal infections- may develop in people with a prolonged illnessor impaired immune system.


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5) Atrophic gastritis- results when antibodies attack the stomach lining,causing it to become very thin and also causes destruction of cellsthat produce acid and enzymes. This condition usually affects the

elderly and those who have had partial gastrectomy ( a procedure inwhich part of the stomach is removed). Atrophic gastritis may causepernicious anemia because it interferes with the absorption ofvitamin B12 from food.

6) Radiation- causes damage to the stomach lining and allowingbacteria to invade the stomach wall, causing a sudden, severe andextremely painful form of gastritis.

7) Unknown causes- Plasma cell gastritis and Menetriere's disease


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BASIS

Gastric pain

Prednisone (Corticosteroid): animmunosuppressive drug alters the normal

protective mechanism of the mucosa of stomachAlcoholism

Laboratory (+) Guaiac Test, positive upper gastrointestinal

bleeding


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Treatment Objectives

Goals of treatment are to relieve thesymptoms and eliminate the gastric irritantor other cause.

To stop or change other kinds of steroids

Hospitalization may be required ifexcessive bleeding occurs.


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Non-pharmacologic Therapy

Don't eat solid food on the first day of the attack.Drink liquids frequently, preferably milk or water.Resume a normal diet slowly, but avoid hot and spicyfoods until symptoms disappear.

Avoid caffeine

Resume normal activities as soon as symptomsimprove.


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Proton PumpInhibitor

H2-ReceptorAntagonist

Antacid Prostaglandin

Efficacy +++ ++ ++ +++

Safety +++ ++ ++ +

Suitability +++ ++ ++ +

Cost +++ ++ + +++

PHARMACOLOGIC THERAPY


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DOC: Omeprazole

It works by decreasing the amount of acid your stomachmakes. It relieves symptoms such as heartburn, difficultyswallowing, and persistent cough. This medication helps healacid damage to the stomach and esophagus, helps prevent

ulcers, and may help prevent cancer of the esophagus.

Omeprazole belongs to a class of drugs known as protonpump inhibitors (PPIs). It shuts down the acid "pumps" within

acid-secreting stomach cells, to limit stomach acidproduction.


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CLINICAL USE:Omeprazole is used to treat certain stomach and esophagus

problems (such as acid reflux, ulcers).

DRUG INTERACTION:Diazepam, phenytoin, warfarin and other Vitamin Kantagonists. Reduce plasma levels of atazanavir. Increaseconcentration of tacrolimus and claritomycin.

alcohol induced seizures

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