Alcoholic epilepsy – group of pathological states at which the convulsive or bessudorozhny attacks connected with alcohol intake are observed. Develops at patients with alcoholism more often. Sometimes arises at single alcoholic excesses at the people who are not suffering from alcoholic dependence. Treats group of symptomatic epilepsies. Can be followed by spasms, automatic actions and violations of consciousness. Treatment provides full refusal of alcohol and reception of anticonvulsive medicines.
Alcoholic epilepsy – the kind of symptomatic epilepsy arising in connection with alcohol intake. Usually develops at the II-III stage of alcoholism. In some cases it can be observed at incidental reception of high doses of alcohol. Includes several pathological states which are followed by convulsive or bessudorozhny attacks. It is more often observed at men at the age of 30-40 years. Characteristic features of this pathology are accurate communication between attacks and episodes of alcohol intake, the high frequency of bessudorozhny attacks, and also lack of epileptic signs on EEG.
At convulsive attacks as a result of falling or blow about firm objects there can be injuries of varying severity. Before an attack the sharp changes of mood which are followed by aggression in relation to people around are possible. Epipripadki at chronic alcoholism often are harbingers alcoholic a deliriya (delirium tremens). Treatment of this disease is performed by experts in the sphere of narcology in cooperation with epileptologa.
Reasons of development and classification of alcoholic epilepsy
Defeat of cells of a brain as a result of toxic effect of alcohol is the main reason for development. The probability of emergence of attacks increases at long hard drinkings, reception of the low-quality alcoholic drinks and alcohol-containing liquids which are not intended for the internal use. As other risk factors allocate craniocereberal injuries (both fresh, and arisen in the past), hereditary predisposition to epilepsy, violations of brain blood circulation, infectious diseases and tumors of a brain.
Now in MKB there is no separate nosological category "alcoholic epilepsy". The convulsive and bessudorozhny attacks which arose in connection with alcohol intake are considered within other diagnostic categories, for example, "alcoholic intoxication with a convulsive attack", "an abstinence syndrome with a convulsive attack" etc. At the same time, in literature the concept "alcoholic epilepsy" can be used when determining several pathological states: epileptic reaction, epileptic syndrome and true alcoholic epilepsy.
- Epileptic reaction – single or incidental attacks which arise against the background of single alcoholic excesses at the people who do not have chronic alcoholism. Usually the attack develops next day after the use of alcohol. After disappearance of symptoms of a hangover attacks stop.
- The epileptic syndrome is widespread more widely than alcoholic epilepsy. It is observed at chronic alcoholism. It is characterized by existence of numerous attacks. Is followed by the mental and somatic violations peculiar to alcoholism. At attacks in some cases there can be auras reminding illusions or hallucinations.
- Alcoholic epilepsy develops seldom, usually – against the background of the long constant use of alcoholic drinks (of 10 years and more) and makes about 10% of total number of the epileptiformny attacks caused by alcohol intake. Attacks usually arise during an abstinence syndrome and quite often pass into alcoholic psychosis.
Symptoms and diagnosis of alcoholic epilepsy
At true alcoholic epilepsy between an attack and reception of alcoholic drinks there is a same accurately expressed interrelation, as between alcohol intake and development of abstinency or alcoholic psychosis. All listed pathological states, as a rule, arise not during the active use, and after a while after the termination of reception of alcohol. Most often epileptic attacks appear in 2-4 days after cancellation or essential reduction of a dose of alcohol, at peak of an abstinence syndrome.
Both convulsive, and bessudorozhny attacks are possible. Character and severity of attacks can differ – from short-term violations of consciousness to serial toniko-clonic attacks and attacks with development of the epileptic status. Bessudorozhny attacks are noted more often convulsive and can be followed by motor avtomatizm, violations of consciousness or episodes of sharply expressed dysphoria. Distinctive feature is lack of polymorphism – once having arisen, attacks proceed according to the same scheme, without change of a clinical picture.
At spasms prevalence of a tonic phase is noted. Absansa (short-term "switching off" of consciousness), psychotouch (a ring, feeling of the category or flash) and psychomotor (changes of consciousness in combination with spasms or motive avtomatizm) attacks are observed seldom. Before a generalized convulsive attack there is a pallor and cyanosis of an upper body. During an attack of the patient falls, throws back the head, strongly (it is frequent – to a gnash) clenches teeth, groans, bends hands and legs. Violations of breath and an involuntary urination are possible.
Some types of epileptic seizures are not distinguished by people around because of the unusual symptoms unknown to the people far from medicine. Among such attacks – sudden stops of the speech, and also pronunciation of the words or phrases which are not corresponding to a topic of conversation and not remaining in memory of the patient not suitable a case. Sometimes attacks arise against the background of harbingers (a dysphoria, sharp strengthening of alarm and irritability) which people around take for signs of alcoholic abstinency.
Distinctive feature are some features of a state and behavior of patients in the postepileptic period. The patients having idiopathic epilepsy after attacks usually feel tired, sluggish, broken. The phase of twilight obscuring of consciousness or psychomotor excitement is less often noted. Patients with alcoholic epilepsy after an attack have sleep disorders: sleeplessness, frequent night and early awakenings and emotionally rich fantastic dreams.
At 50% of the patients having attacks in connection with alcohol intake against the background of sleeplessness in 1-2 days after an attack develops deliriya, accompanied with bright visual hallucinations at which there are devils, aliens, fantastic beings etc. Over time attacks are not made heavier as it quite often happens at idiopathic epilepsy. Prevalence of the personal changes characteristic of alcoholic degradation, but not for epileptic process is noted.
The diagnosis is exposed taking into account the anamnesis and clinical manifestations. Instructions on the long use of alcoholic drinks, lack of attacks before emergence of alcoholic dependence and communication between attacks and refusal of alcohol intake have diagnostic value. The maloinformativna given additional researches, epileptic signs on the electroencephalogram usually are absent.
Treatment and the forecast at alcoholic epilepsy
Patients with the epileptic status and repeated attacks are hospitalized in intensive care unit for maintenance of the vital functions of an organism. Carry out transfusions of glucose and salt solutions, enter diazepam, hexabarbital and tiopentat. Other patients are directed to inspection and treatment in narcological office. Apply anticonvulsive means (usually – carbamazepine). Phenobarbital is used seldom as this medicine is contraindicated at alcoholism. An exception – the attacks steady against action of other anticonvulsive means. In the presence of sufficient indications phenobarbital is appointed only in the conditions of a hospital, under constant control of a condition of the patient.
Indispensable condition of successful therapy of this pathology is complete cessation of reception of alcoholic drinks. Tactics of treatment of alcoholic dependence is defined by the narcologist. The individual and group psychotherapy, gipnosuggestivny technicians, medicamentous coding with use of implants and medicines can be applied to intravenous administration. If necessary the patient is given the direction in specialized rehabilitation clinic.
At full refusal of alcohol forecast favorable. In most cases attacks completely disappear. Changes of the personality, characteristic of epilepsy, are not observed, expressiveness of mental disorders and personal violations is defined by duration and weight of alcoholization. At continuation of the use of alcohol increase of attacks is possible. The threat for life of the patient can arise at development of the epileptic status and alcoholic psychosis, and also at injuries owing to generalized convulsive attacks.