Kim Dong Wook, Kim Hyun Kyung, Bae Eun-Kee, Park So-Hee, Kim Kwang Ki
Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.
Department of Neurology, National Medical Center, Seoul, Korea.
Am J Emerg Med. 2015 May;33(5):701-4. doi: 10.1016/j.ajem.2015.02.030. Epub 2015 Feb 23.
Delirium tremens (DT) is the severest form of alcohol withdrawal syndrome, frequently after alcohol withdrawal seizures. Delirium tremens occurs in a small proportion of patients with alcohol withdrawal seizures; nevertheless, early identification of high-risk patients is important for intensive preventive management of unexpected episodes due to agitation and its associated increased mortality. However, there are limited studies on clinical predictors of the development of DT in patients with alcohol withdrawal seizures.
Patients who visited the emergency department with acute seizures were included in the study when alcohol withdrawal was the only or the strongest precipitating factor for seizures. All patients were carefully observed for at least 48 hours in the intensive care unit after the initial assessment to closely monitor vital signs and development of DT. Clinical and laboratory findings were analyzed for predicting the development of DT.
Of the 97 patients (82 males; mean age, 48.6 ± 13.3 years) with alcohol withdrawal seizures, 34 (35.1%) developed DT. Low platelet count, high blood level of homocysteine, and low blood level of pyridoxine were associated with the subsequent development of DT. Low platelet count and high blood level of homocysteine were independent risk factors with high diagnostic sensitivity and specificity for the development of DT.
The study indicated that some easily determined parameters are potential clinical predictors for the development of DT in patients with alcohol withdrawal seizures. These findings would be helpful in clinical identification and management patients at high risk for DT.
震颤谵妄（DT）是酒精戒断综合征最严重的形式，常发生于酒精戒断性癫痫发作之后。震颤谵妄在一小部分酒精戒断性癫痫发作的患者中出现；然而，早期识别高危患者对于因激越及其相关死亡率增加导致的意外事件的强化预防管理很重要。然而，关于酒精戒断性癫痫发作患者发生DT的临床预测因素的研究有限。
当酒精戒断是癫痫发作的唯一或最主要诱发因素时，因急性癫痫发作就诊于急诊科的患者被纳入研究。所有患者在初始评估后在重症监护病房至少仔细观察48小时，以密切监测生命体征和DT的发生情况。分析临床和实验室检查结果以预测DT的发生。
在97例（82例男性；平均年龄48.6±13.3岁）酒精戒断性癫痫发作患者中，34例（35.1%）发生了DT。血小板计数低、同型半胱氨酸血水平高和维生素B6血水平低与随后发生DT有关。血小板计数低和同型半胱氨酸血水平高是DT发生的独立危险因素，对DT的发生具有高诊断敏感性和特异性。
该研究表明，一些易于确定的参数是酒精戒断性癫痫发作患者发生DT的潜在临床预测因素。这些发现将有助于临床识别和管理DT高危患者。
