Convulsões relacionadas ao alcoolismo: atualização / Seizures related to alcoholism: update

OBJETIVO: Revisão sobre crises convulsivas relacionadas ao alcoolismo,discutindo sua classificação, fisiopatologia, investigação diagnóstica e seu tratamento. MÉTODO: Revisão não sistemática de artigos utilizando-se os unitermos: "alcoholism", "alcohol", "seizures" e "withdrawal". Priorizou-se a utilização de artigos que apresentassem associação desses unitermos no título. Foram utilizadas as bases de dados do PubMed, Lilacs e Google Scholar. RESULTADOS: Foram encontrados 2.362 artigos associando os unitermos no título, tendo sido escolhidos 26 artigos em inglês, 3 em português, 1 manual e 1 tese em inglês para a elaboração desta revisão. CONCLUSÃO: As crises convulsivas relacionadas ao álcool representam uma das mais graves complicações do alcoolismo. O diagnóstico e o tratamento corretos melhoram o prognóstico desses indivíduos, diminuindo o risco de complicações, a recorrência de crises, a ocorrência de status epilepticus ou a evolução para um quadro de delirium tremens.

OBJECTIVE: Review alcoholism related seizures, discussing classification,pathophysiology, diagnosis and treatment. METHOD: A non-systematic review was performed of articles using the keywords: "alcoholism", "alcohol", "seizures", and "withdrawal". Articles with the combination of these keywords in the title were favored. The search was performed on PubMed, Lilacs database and Google Scholar. RESULTS: Using these search terms 2,362 articles were found, being selected 26 articles in English, 3 articles in Portuguese, 1 English manual, and 1 thesis in English to elaborate this review. CONCLUSION: Seizures related to alcohol are one of the most serious complications of alcoholism. The correct diagnosis and treatment improves the prognosis of these individuals, decreasing the risk of complications,seizure recurrence, status epilepticus and the progression to delirium tremens.

Predictive value of the bispectral index for burst suppression on diagnostic electroencephalogram during drug-induced coma.

STUDY PURPOSE: To determine correlation and predictive value between data obtained with the bispectral index (BIS) and diagnostic electroencephalogram (EEG) in determining degree of burst suppression during drug-induced coma. This study seeks to answer the question: "To what degree can EEG suppression and burst count as measured by diagnostic EEG during drug-induced coma be predicted from data obtained from the BIS such as BIS value, suppression ratio (SR), and burst count?" BACKGROUND/SIGNIFICANCE: During drug-induced coma, cortical EEG is the gold standard for real-time monitoring and drug titration. Diagnostic EEG is, from setup through data analysis, labor intensive, costly, and difficult to maintain uniform clinician competency. BIS monitoring is less expensive, less labor-intensive, and easier to interpret data and establish/maintain competency. Validating BIS data versus diagnostic EEG facilitates effective brain monitoring during drug-induced coma at lower cost with similar outcomes. METHOD: This is a prospective, observational cohort study. Four consecutive patients receiving drug-induced coma/EEG monitoring were enrolled. BIS was initiated after informed consent. Variables recorded per minute included presence or absence of EEG burst suppression, burst count, BIS value over time, burst count, and SR. Pearson's product-moment and Spearman rank coefficient for BIS value and SR versus burst count were performed. Regression analysis was utilized to plot BIS values versus bursts/minute on EEG as well as SR versus burst count on EEG. EEG/BIS data were collected from digital data files and transcribed onto data sheets for corresponding time indices. RESULTS: Four patients yielded 1,972 data sets over 33 hours of EEG/BIS monitoring. Regression coefficient of 0.6673 shows robust predictive value between EEG burst count and BIS SR. Spearman rank coefficient of -0.8727 indicates strong inverse correlation between EEG burst count and BIS SR. Pearson's correlation coefficient between EEG versus BIS burst count was .8256 indicating strong positive correlation. Spearman's rank coefficient of 0.8810 and Pearson's correlation coefficient of .6819 showed strong correlation between BIS value versus EEG burst count. Number of patients (4) limits available statistics and ability to generalize results. Graphs and statistics show strong correlation/predictive value for BIS parameters to EEG suppression. CONCLUSIONS: This study is the first to measure correlation and predictive value between BIS monitoring and diagnostic EEG for degree of EEG suppression and burst count in the adult population. Available statistic tests and graphing of variables from BIS and diagnostic EEG show strong correlation and predictive value between both monitoring technologies during drug-induced coma. These support using BIS value, SR, and burst count to predict degree of EEG suppression in real time for titrating metabolic suppression therapy.

Clinical correlates of quantitative EEG alterations in alcoholic patients.

OBJECTIVE: To evaluate the incidence and clinical correlations of abnormal QEEG features in alcoholic patients. METHODS: Quantitative EEG (frequency analysis, absolute and relative powers of the four classical bands) was assessed in 191 male alcoholic patients admitted in our facility for detoxification process. All underwent psychiatric, medical and neurological examination prior to the EEG recording, in search for specific clinical or paraclinical findings. The presence or absence of relevant clinical features was codified as nominal dichotomic variables to be related to specific QEEG features. RESULTS: Only 7 patients had normal QEEG. The most frequent alteration (81 cases) was decreased power in slow (delta and theta) bands with a concurrent increase in beta band, followed by decreased power only in slow bands (33), increase only in beta band (29), decrease in both slow and alpha bands without beta alterations (28), decrease only in alpha band (6) and others. Alterations in slow and beta bands were uncorrelated. However, a significant correlation was found between decreased power in slow bands and cortical atrophy as revealed by MRI (especially in patients with early onset of alcoholism), time elapsed from the beginning of alcoholic habits (but only in younger or early onset subjects) and in a lesser degree arterial hypertension, but neither with age nor any other clinical or psychiatric feature. On the other hand, increased power in beta band correlated mainly with the use of benzodiazepines, sensoperceptual alterations (hallucinations, illusions), clinical seizures and family history of alcoholism. The effects of those variables were strongly interrelated. CONCLUSIONS: Decreased power in slow bands in alcoholic patients may be an indicator of brain atrophy or chronic brain damage, while increase in beta band is related to medication use, family history of alcoholism, hallucinations and seizures, suggesting a state of cortical hyperexcitability. SIGNIFICANCE: This study show the relation of specific QEEG alterations to certain clinical features found in alcoholics, in a further attempt to elucidate the semiological value of those alterations in individual patients.

Sonhos e craving em alcoolistas na fase de desintoxicação / Dreams and craving in alcohol addicted patients in the detoxication stage

O objetivo desta pesquisa foi avaliar a presença da relação entre os sonhos e craving em alcoolistas nos três primeiros dias de desintoxicação em unidades de internação hospitalar. Verificou-se se aqueles que tinham o craving aumentado relatavam sonhos com o tema "álcool" e analisou-se a qualidade do sono desses sujeitos. Foi um estudo transversal, de associação entre variáveis. A amostra foi de 77 sujeitos adultos do sexo masculino, dependentes de álcool, sem comorbidades clínicas ou psiquiátricas e não-dependentes de outras substâncias psicoativas, salvo a nicotina. Os instrumentos foram: entrevista estruturada; escala de avaliação do craving; questionário de avaliação do sono e dos sonhos; Mini-Mental State Examination e questionário Short-Form Alcohol Dependence Data. Quanto à fase inicial do sono, 67,6 por cento considerou no mínimo satisfatória, 80,5 por cento emitiu a mesma opinião quanto ao seu final, porém apenas 22,1 por cento nunca apresentou interrupções durante o sono. Sonhar com álcool não foi um comportamento freqüente (27,3 por cento), e a média de pontuação do craving foi "fraca", havendo associação entre sonhar com álcool e um aumento no craving (p < 0,001). Os sonhos podem ser mais bem aproveitados pelos profissionais da dependência química, devendo ser utilizados elementos sinalizadores de uma "situação de risco" nas técnicas de prevenção à recaída.

The effects of alcohol intake and withdrawal on the seizures frequency and hippocampal morphology in rats with epilepsy.

The aim of our study, using the pilocarpine model of epilepsy, was to investigate the effects of alcohol administration and withdrawal on the spontaneous recurrent seizures (SRSs). Four groups of adult, male Wistar rats were studied: (A). control rats (n=10), received neither pilocarpine nor alcohol, (B). alcohol-treated rats (n=10), received a daily dose of 3.0 g x kg(-1) of a 30% alcohol solution via an oesophagic probe for 30 days, (C). rats with epilepsy (n=10), (D). rats with epilepsy with alcohol intake (n=10). SRSs were induced by a single dose of pilocarpine (i.p.) and the basal frequency of SRSs was video monitored (24h per day) for 30 days. Following this period, the animals of group D received a daily dose of alcohol solution as described above and at the end of this period, alcohol administration was stopped and the seizure frequency was assessed for more 30 days. The basal seizure frequency observed in groups C and D during the first 30 days was 2.2+/-1.8 seizures per week per animal. In group D, it was observed an increase to 12.2+/-5.8 during the first 2 weeks of alcohol administration. During the last 2 weeks of alcohol administration, the number of SRSs returned to the previous basal level. During alcohol withdrawal the seizure frequency increased to 14.3+/-7.4 seizures per week per animal for the first 2 weeks, and returned to the basal level in the remaining period of observation. The Neo-Timm and Nissl staining of hippocampal formation and of the dentate gyrus in rats with epilepsy showed a cell loss in the hippocampal subfield CA1 and in the hillus of dentate gyrus. In rats with epilepsy with alcohol intake, we observed a cell loss in hippocampal subfields CA3 and hillus of the dentate gyrus, with significant neuronal death in subfield CA1, when compared with control animals. The alcohol withdrawal syndrome is a crucial event for the development of functional and neuropathological alterations associated with epilepsy.

Síndrome de abstinência alcoólica / Alcohol abstinence syndrome

O alcoolismo é um dos problemas mais importantes de Saúde Mental no Brasil, com uma prevalência durante a vida variando de 7,6 a 9,2 por cento, sendo 10 vezes mais freqüente em homens do que em mulheres (ALMEIDA FILHO e col, 1997). Considerando-se o conceiro mais almplo de "bebedores problemas", ou seja, pessoas que ainda näo desenvolveram uma nítida dependência ao álcool, mas já apresentam alguma conseqüência do seu uso abusivo, pode-se estimar um aumento de quatro vezes destas proporçöes (JORGE, 1987)