Focal nonconvulsive seizures during detoxification for benzodiazepine abuse.
Chronic benzodiazepine (BDZ) abuse is currently treated with detoxification using a low-dose flumazenil infusion, a relatively recently developed and promising procedure. Given the possibility reported in the literature of the occurrence of generalized seizures during therapeutic BDZ detoxification, we usually administer preventive antiepileptic drug (AED) therapy. We describe two patients with no previous history of seizures or evidence of intracerebral lesions who, during detoxification for benzodiazepine abuse, developed repetitive focal nonconvulsive seizures instead of generalized seizures, even with appropriate doses of preventive AED therapy. There are no previous reported cases of focal nonconvulsive seizures occurring during this procedure or, more generally, during abrupt BDZ discontinuation. The cases we describe suggest that during detoxification for BDZ abuse, not only generalized, but also focal nonconvulsive seizures may occur. In this context, the focal seizures probably result from a diffuse decrease in the seizure threshold (caused by a generalized excitatory rebound), which may trigger focal seizures arising from cortical regions with higher intrinsic epileptogenicity. Detoxification for benzodiazepine abuse, even if performed with adequate-dosage AED treatment, may not be as safe a procedure as previously considered, because not only convulsive, but also nonconvulsive seizures may occur and go unnoticed. It is therefore strongly advisable to perform this detoxification under close medical supervision and to maintain a low threshold for EEG monitoring in the event of sudden onset of behavioral changes.
Department of Medicine D, Addiction Unit, University of Verona, Verona, Italy.
Anna
A
Albiero
Francesco
F
Brigo
Marco
M
Faccini
Rebecca
R
Casari
Gianluca
G
Quaglio
Monica
M
Storti
Antonio
A
Fiaschi
Luigi Giuseppe
LG
Bongiovanni
Fabio
F
Lugoboni
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines; D005260:Female; D005442:Flumazenil / Q000008:administration & dosage / Q000009:adverse effects*; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D012640:Seizures / Q000139:chemically induced* / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome; D019966:Substance-Related Disorders / Q000628:therapy*; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D018757:GABA Modulators; D001569:Benzodiazepines; D005442:Flumazenil; D014635:Valproic Acid