title: Homocysteine levels in patients classified according to Lesch's typology.
abstract: OBJECTIVE
  It has been suggested that elevated total plasma homocysteine levels might be useful to predict alcohol withdrawal seizures. The typology by Lesch distinguishes between four subtypes of which type 1 suffers from marked withdrawal symptoms, including alcohol withdrawal seizures. This study was undertaken to investigate total plasma homocysteine levels in actively drinking patients with alcoholism who were classified according to Lesch's typology.
  
  
  METHODS
  We determined total plasma homocysteine levels in 144 non-abstinent chronic alcoholics (115 men, 29 women; aged 22-67 years). Patients were classified in Lesch's typology (LT) and were divided into two groups: LT 1 (n = 27) and LT 2-4 (n = 117). Within the groups, patients with or without a history of alcohol withdrawal seizures were differentiated.
  
  
  RESULTS
  All patients with a history of alcohol withdrawal seizures had significantly elevated plasma homocysteine concentrations at admission when compared with those without seizures (Mann-Whitney U, P < 0.001). Furthermore, patients classified as LT 1 who suffered from an alcohol withdrawal seizure (n = 12) had significantly higher plasma homocysteine levels (Z = -2.31, P = 0.02) when compared to the corresponding types 2-4 (n = 24). Using a logistic regression analysis, withdrawal seizures were best predicted by a high homocysteine level at admission but even more pronounced in LT 1 (Wald's chi-squared [chi(2)] = 10.7; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03-1.51; P < 0.001) when compared with LT 2-4 (chi(2) = 10.6; OR 1.06; 95%CI 1.03-1.14; P = 0.004).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study evaluating homocysteine levels in patients who were classified according to Lesch's typology. Homocysteine levels on admission may be a useful screening method to identify actively drinking patients at risk of alcohol withdrawal seizures, especially in alcoholics with Lesch type 1.
authors.affiliation: Friedrich-Alexander, University of Erlangen-Nuremberg, Department of Psychiatry and Psychotherapy, Schwabachanlage 6, D-91054 Erlangen, Germany. stefan.bleich@psych.imed.uni-erlangen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Bleich
authors.forename: Kristina
authors.initials: K
authors.lastname: Bayerlein
authors.forename: Udo
authors.initials: U
authors.lastname: Reulbach
authors.forename: Thomas
authors.initials: T
authors.lastname: Hillemacher
authors.forename: Dominikus
authors.initials: D
authors.lastname: Bönsch
authors.forename: Birgit
authors.initials: B
authors.lastname: Mugele
authors.forename: Johannes
authors.initials: J
authors.lastname: Kornhuber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sperling
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000097:blood*; D016009:Chi-Square Distribution; D003663:Decision Trees; D000431:Ethanol / Q000633:toxicity*; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012640:Seizures / Q000097:blood / Q000139:chemically induced*; D018709:Statistics, Nonparametric; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000150:complications*
chemical_list: D006710:Homocysteine; D000431:Ethanol