Long‐term outcome of alcohol withdrawal seizures

Article Article scientifique Article Long‐term outcome of alcohol withdrawal seizures eng 2023-10-12 2023-10-12 author Sansonetti Riccardo Giulio 0000-0002-3685-7108 Department of Clinical Neurosciences University Hospital of Geneva & Faculty of Medicine Geneva Switzerland 34374 author Megevand Pierre Bastien 0000-0002-0427-547X Department of Clinical Neurosciences University Hospital of Geneva & Faculty of Medicine Geneva Switzerland 510484 Département des neurosciences cliniques (OTONO) author Vulliemoz Serge 0000-0002-1877-8625 Department of Clinical Neurosciences University Hospital of Geneva & Faculty of Medicine Geneva Switzerland 712268 Département des neurosciences cliniques (OTONO) author Corbetta Maurizio Department of Neuroscience University of Padova Padova Italy author Picard Fabienne Department of Clinical Neurosciences University Hospital of Geneva & Faculty of Medicine Geneva Switzerland 123049 Département des neurosciences cliniques (OTONO) author Seeck Margitta Department of Clinical Neurosciences University Hospital of Geneva & Faculty of Medicine Geneva Switzerland 133679 Département des neurosciences cliniques (OTONO) e16075 10.1111/ene.16075 37823698 1351-5101 https://onlinelibrary.wiley.com/doi/10.1111/ene.16075 Background and purpose Alcohol withdrawal seizures (AWS) are a well‐known complication of chronic alcohol abuse, but there is currently little knowledge of their long‐term relapse rate and prognosis. The aims of this study were to identify risk factors for AWS recurrence and to study the overall outcome of patients after AWS. Methods In this retrospective single‐center study, we included patients who were admitted to the Emergency Department after an AWS between January 1, 2013 and August 10, 2021 and for whom an electroencephalogram (EEG) was requested. AWS relapses up until April 29, 2022 were researched. We compared history, treatment with benzodiazepines or antiseizure medications (ASMs), laboratory, EEG and computed tomography findings between patients with AWS relapse (r‐AWS) and patients with no AWS relapse (nr‐AWS). Results A total of 199 patients were enrolled (mean age 53 ± 12 years; 78.9% men). AWS relapses occurred in 11% of patients, after a median time of 470.5 days. Brain computed tomography ( n = 182) showed pathological findings in 35.7%. Risk factors for relapses were history of previous AWS ( p = 0.013), skull fractures ( p = 0.004) at the index AWS, and possibly epileptiform EEG abnormalities ( p = 0.07). Benzodiazepines or other ASMs, taken before or after the index event, did not differ between the r‐AWS and the nr‐AWS group. The mortality rate was 2.9%/year of follow‐up, which was 13 times higher compared to the general population. Risk factors for death were history of AWS ( p < 0.001) and encephalopathic EEG ( p = 0.043). Conclusions Delayed AWS relapses occur in 11% of patients and are associated with risk factors (previous AWS >24 h apart, skull fractures, and pathological EEG findings) that also increase the epilepsy risk, that is, predisposition for seizures, if not treated. Future prospective studies are mandatory to determine appropriate long‐term diagnostic and therapeutic strategies, in order to reduce the risk of relapse and mortality associated with AWS. EEG Alcohol-withdrawal seizures Head trauma Mortality Risk factors Dewey 616.8 Swiss National Science Foundation Predict and Monitor Epilepsy After a First Seizure: The Swiss-First Study 180365 CH Programmes Swiss National Science Foundation Precision mapping of electrical brain network dynamics with application to epilepsy 209470 CH Programmes Swiss National Science Foundation Neuronal biomarkers of seizure activity in human epilepsy 194507 CH Careers Swiss National Science Foundation Network Diagnosis for Epilepsy 192749 CH Projects 61 Département des neurosciences cliniques 226 false 119 Epilepsie et Chirurgie 149 1279 Epilepsie et réseaux cérébraux 1002 1361 Human Neuron Lab 1034 European journal of neurology 31 1 80ac6e72-3576-4486-9a3f-205b1546937a Article (Accepted version) Public Sansone et al_2023.pdf 1012790 application/pdf CC BY-NC-4.0 8bc7f54786fa597f7a52c15c8cfb6919764686773c2eefdb7f6d791bed74b0e3 openAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Long‐term outcome of alcohol withdrawal seizures	European journal of neurology			2023	125	1,666

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Sansonetti, Riccardo Giulio