Department of Clinical Neurosciences, University Hospital of Geneva & Faculty of Medicine, Geneva, Switzerland.
Department of Neuroscience, University of Padova, Padova, Italy.
Eur J Neurol. 2024 Jan;31(1):e16075. doi: 10.1111/ene.16075. Epub 2023 Oct 12.
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.
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).
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).
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.
酒精戒断性癫痫发作（AWS）是慢性酒精滥用的一种常见并发症，但目前对于其长期复发率和预后知之甚少。本研究的目的是确定 AWS 复发的危险因素，并研究 AWS 后患者的总体结局。
本回顾性单中心研究纳入了 2013 年 1 月 1 日至 2021 年 8 月 10 日期间因 AWS 入住急诊部并接受脑电图（EEG）检查的患者。研究截至 2022 年 4 月 29 日的 AWS 复发情况。我们比较了 AWS 复发患者（r-AWS）和无 AWS 复发患者（nr-AWS）的病史、苯二氮䓬类药物或抗癫痫药物（ASM）治疗、实验室、EEG 和计算机断层扫描（CT）结果。
共纳入 199 例患者（平均年龄 53±12 岁，78.9%为男性）。11%的患者发生 AWS 复发，中位时间为 470.5 天。182 例头颅 CT 显示有病理发现（35.7%）。复发的危险因素为既往有 AWS 史（p=0.013）、指数 AWS 时颅骨骨折（p=0.004）和可能存在癫痫样 EEG 异常（p=0.07）。在指数事件之前或之后使用苯二氮䓬类药物或其他 ASM 治疗在 r-AWS 组和 nr-AWS 组之间无差异。随访期间的死亡率为 2.9%/年，是普通人群的 13 倍。死亡的危险因素为 AWS 史（p<0.001）和脑病性 EEG（p=0.043）。
11%的患者会发生迟发性 AWS 复发，且与增加癫痫风险的危险因素（24 小时以上的间隔时间、颅骨骨折和异常 EEG）相关，如果不治疗，这些危险因素会增加癫痫发作的易感性。未来需要进行前瞻性研究，以确定适当的长期诊断和治疗策略，从而降低与 AWS 相关的复发和死亡率。
