Samsonsen Christian, Myklebust Harald, Strindler Tåle, Bråthen Geir, Helde Grethe, Brodtkorb Eylert
Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway.
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
Epilepsy Res. 2018 Jul;143:82-89. doi: 10.1016/j.eplepsyres.2018.04.007. Epub 2018 Apr 13.
The aim of this study was to investigate the association between alcohol use and seizures in acutely hospitalized patients. We wished to study the extent of the problem as well as the clinical characteristics of people with various forms of alcohol-related seizures, including their drinking pattern.
After admission, a semi-structured interview took place with 134 consecutive patients (epilepsy 92, single seizures 42). Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT) and by the number of alcohol units consumed during 6 days prior to the seizure. Sleep time was recorded during the previous 3 days and nights. A follow-up telephone interview covering the same weekdays was performed on a seizure-free day at least 4 weeks later.
28% of patients had AUDIT scores ≥8 (hazardous drinking); 22% in epilepsy, 43% in single seizures (p = .012). Non-focal seizures were increased in single seizures, suggesting a withdrawal mechanism. In the 58 epilepsy patients with social drinking (excluded hazardous drinking or excessive binging), the alcohol intake was not different prior to seizure compared to follow-up, downgrading the role of modest alcohol intake as a seizure precipitant in epilepsy. On the other hand, a high percentage of binge drinkers had epilepsy (57%), and in the subgroup of Idiopathic Generalized Epilepsy (IGE) even social drinking was associated with seizures. Seizures peaked on Sundays and Mondays. Less sleep prior to the seizure was associated with hazardous drinking.
Alcohol is a major seizure precipitant in the context of hazardous drinking and withdrawal. In people with epilepsy, occasional binge drinking is associated with loss of seizure control. Social drinking is an uncommon cause of seizure breakthrough in predominantly focal epilepsy, but caution is warranted in IGE. Alcohol intake prior to a seizure is often accompanied by other triggers, such as sleep loss. Alcohol alone should not always be blamed.
本研究旨在调查急性住院患者饮酒与癫痫发作之间的关联。我们希望研究该问题的严重程度以及各种形式酒精相关癫痫发作患者的临床特征，包括他们的饮酒模式。
入院后，对134例连续患者（92例癫痫患者，42例单次发作患者）进行了半结构化访谈。通过酒精使用障碍识别测试（AUDIT）以及发作前6天内饮用的酒精单位数量来评估饮酒情况。记录前3天和夜晚的睡眠时间。至少4周后，在无癫痫发作日进行了一次涵盖相同工作日的随访电话访谈。
28%的患者AUDIT评分≥8（危险饮酒）；癫痫患者中为22%，单次发作患者中为43%（p = 0.012）。单次发作患者中非局灶性癫痫发作增加，提示存在戒断机制。在58例社交饮酒的癫痫患者（排除危险饮酒或过度暴饮）中，发作前的酒精摄入量与随访时相比无差异，这降低了适度饮酒作为癫痫发作诱因的作用。另一方面，高比例的暴饮者患有癫痫（57%），在特发性全面性癫痫（IGE）亚组中，甚至社交饮酒也与癫痫发作有关。癫痫发作在周日和周一达到峰值。发作前睡眠较少与危险饮酒有关。
在危险饮酒和戒断的情况下，酒精是癫痫发作的主要诱因。在癫痫患者中，偶尔暴饮与癫痫发作控制丧失有关。社交饮酒是主要为局灶性癫痫发作突破的罕见原因，但在IGE中应谨慎。癫痫发作前饮酒通常伴有其他触发因素，如睡眠不足。不应总是将责任归咎于酒精本身。
