seizures related to suds
TRANSCRIPT
AHMED ELAGHOURYEgyptian & Arab Boards in Psychiatry
Abbassia Hospital for Mental Health, MOH
Cairo, Egypt
SEIZURES RELATED TO
SUDs
Basic concepts Seizures: attacks
Epilepsy / Epilepsies: disorder,
unprovoked seizures
Convulsions: motor seizures
Acute symptomatic seizures, ASS:
provoked ,
PNES / NES: psychogenic nonepileptic
seizures “pseudoseizures”
Cairo, DEC 20142 [email protected]
So, SUDs may be a risk factor for:
TBI
CNS infection
CVA
Also, withdrawal or intoxication are
provocation states to seizures
Cairo, DEC 20145 [email protected]
ASS ASS: provoked seizures, occasional seizures,
reactive seizures, or situation related seizures.
ILAE classification: ASS fall into the category of
‘‘conditions with epileptic seizures that do not
require a diagnosis of epilepsy’’
Clear cause, Do not recur & different prognosis
More frequent: more than 50% of seizures in
medical facilities
May be a risk factor for epilepsy, esp if “remote”
Cairo, DEC 20146 [email protected]
Panayiotopoulos CP (editor) , Atlas of epilepsies. 2010, Springer.
Semiology Commonly: Motor (P/G), status
epilepticus
Rarely: Absence, complex partial and
atonic seizures
Cairo, DEC 20147 [email protected]
Panayiotopoulos CP (editor) , Atlas of epilepsies. 2010, Springer.
Which substance? Alcohol: alcohol related seizures, ARS
Opioids: esp tramadol in Egypt
Sedative / Hypnotics / Anxiolytics
Stimulants
Inhalants
Hallucingens
Cannabinoids: ±
Cairo, DEC 20148 [email protected]
Selection of AEDs Stabilize pt: ABC
Acute: Diazepam, Lorazepam,
Midazolam
Maintenance (when needed): CBZ, GBP
“partial” LMT, VPA “generalized”
Consider the remission criterion of
SUDs: 3 – 12 ms is an early remission in
DSM5
Consider prolonged T1/2 of some drugs:
eg clonazepam Cairo, DEC 20149 [email protected]