Download PDF
Psychiatr Prax 2010; 37(6): 271-278
DOI: 10.1055/s-0030-1248443
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des Alkoholentzugssyndroms: Fokus auf Delirium tremens und Entzugskrampfanfall

Diagnostics and Therapy of Alcohol Withdrawal Syndrome: Focus on Delirium Tremens and Withdrawal SeizureUlrich  C.  Lutz1 , Anil  Batra1
  • 1Universitätsklinik für Psychiatrie und Psychotherapie, Sektion für Suchtmedizin und Suchtforschung, Tübingen
Further Information

Publication History

Publication Date:
27 August 2010 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung Die schwerwiegendsten Komplikationen des Alkoholentzugssyndroms sind der Entzugskrampfanfall und das Delirium tremens. Die Übersichtsarbeit stellt das notwendige diagnostische, therapeutische und prophylaktische Vorgehen sowie nichtpharmakologische Therapiemaßnahmen beim Delirium tremens und eine mögliche Integration von Videoaufnahmen des Delirium tremens im Rahmen der Motivationsbehandlung dar. Methodik Systematische Literaturrecherche mithilfe der Datenbank Pubmed. Ergebnisse und Diskussion Beim Auftreten eines Entzugskrampfanfalls bzw. eines Delirium tremens muss zwischen einer Basisdiagnostik und einer weiterführenden, zustandsabhängigen Diagnostik (Bildgebung, Liquorpunktion) unterschieden werden. In der Behandlung und Prophylaxe des Entzugssyndroms haben Sedativa einen hohen Stellenwert. Eine dauerhafte antikonvulsive Medikation nach einem Entzugskrampfanfall ist äußerst kritisch zu prüfen.

Abstract

Introduction Delirium tremens and withdrawal seizures are serious complications of an alcohol withdrawal syndrome. This review presents the diagnostic procedures required in case of the occurrence of a withdrawal seizure and delirium tremens as well as possible treatment options including prophylactic medication regimen for alcohol withdrawal syndrome. Furthermore non-pharmacological procedures accompanying delirium tremens and a potential integration of viewing videotapes of delirium tremens in the course of alcohol-specific therapy are discussed. Methods A systematic literature research using Pubmed has been carried out to find recent studies and review articles dealing with alcohol withdrawal syndrome. Results and Discussion Regarding the diagnostic algorithm in case of the occurrence of a withdrawal seizure or a delirium tremens basic diagnostic procedures and special diagnostics including neuro-imaging or cerebrospinal fluid puncture depending on patients' clinical condition have to be considered. Sedatives are important in treatment of alcohol withdrawal seizures and delirium tremens as well as in the prophylaxis of alcohol withdrawal syndrome. A long-lasting prescription of anticonvulsant medication in patients suffering from withdrawal seizure should be considered critically and can be carried out only under certain conditions.

Schlüsselwörter

Alkoholentzug - Delirium tremens - Krampfanfall - Therapie - Diagnostik

Keywords

alcohol withdrawal - delirium tremens - seizure - therapy - diagnostics

Literatur

  • 1 Küfner H, Kraus L. Epidemiologische und ökonomische Aspekte des Alkoholismus.  Dtsch Arztebl. 2002;  99 936-945
    PubMedGoogle Scholar
  • 2 Bergmann E, Horch K. Ökonomische Bewertung von gesundheitlichen Folgen des Alkoholismus.  Sucht aktuell. 2000;  2 14-18
    PubMedGoogle Scholar
  • 3 Bundesministerium für Gesundheit .Drogen- und Suchtbericht. http://www.bmgs.bund.de 2008
    PubMedGoogle Scholar
  • 4 Wetterling T. Delir – der Stand der Forschung.  Fortschr Neurol Psychiatr. 1994;  62 280-289
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Erwin W E, Williams D B, Speir W A. Delirium tremens.  South Med J. 1998;  91 425-432
    CrossrefPubMedGoogle Scholar
  • 6 Zilker T. Alkoholentzugssyndrom und Delirium tremens.  MMW Fortschr Med. 1999;  141 26-30
    PubMedGoogle Scholar
  • 7 Ferguson J A, Suelzer C J, Eckert G J. et al . Risk factors for delirium tremens development.  J Gen Intern Med. 1996;  11 410-414
    CrossrefPubMedGoogle Scholar
  • 8 Lutz U C, Batra A. Das Alkoholentzugssyndrom: Delirium tremens und Krampfanfall – eine Übersicht über die Ätiopathogenese.  SUCHT. 2010 (in Druck); 
    PubMedGoogle Scholar
  • 9 Victor M, Brausch C. The role of abstinence in the genesis of alcoholic epilepsy.  Epilepsia. 1967;  8 1-20
    CrossrefPubMedGoogle Scholar
  • 10 Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management.  CNS Drugs. 2003;  17 1013-1030
    CrossrefPubMedGoogle Scholar
  • 11 Hillbom M E. Occurrence of cerebral seizures provoked by alcohol abuse.  Epilepsia. 1980;  21 459-466
    CrossrefPubMedGoogle Scholar
  • 12 Krumholz A, Grufferman S, Orr S T. et al . Seizures and seizure care in an emergency department.  Epilepsia. 1989;  30 175-181
    CrossrefPubMedGoogle Scholar
  • 13 Forsgren L. Prevalence of epilepsy in adults in northern Sweden.  Epilepsia. 1992;  33 450-458
    CrossrefPubMedGoogle Scholar
  • 14 Granieri E, Rosati G, Tola R. et al . A descriptive study of epilepsy in the district of Copparo, Italy, 1964–1978.  Epilepsia. 1983;  24 502-514
    CrossrefPubMedGoogle Scholar
  • 15 Chan A W. Alcoholism and epilepsy.  Epilepsia. 1985;  26 323-333
    CrossrefPubMedGoogle Scholar
  • 16 Foy A, Kay J. The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population.  Drug Alcohol Rev. 1995;  14 49-54
    CrossrefPubMedGoogle Scholar
  • 17 Kosten T R, O'Connor P G. Management of drug and alcohol withdrawal.  N Engl J Med. 2003;  348 1786-1795
    CrossrefPubMedGoogle Scholar
  • 18 Sullivan J T, Sykora K, Schneiderman J. et al . Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).  Br J Addict. 1989;  84 1353-1357
    CrossrefPubMedGoogle Scholar
  • 19 Wetterling T, Kanitz R D, Besters B. et al . A new rating scale for the assessment of the alcohol-withdrawal syndrome (AWS scale).  Alcohol Alcohol. 1997;  32 753-760
    PubMedGoogle Scholar
  • 20 Soyka M, Küfner H, Feuerlein W. Alkoholismus – Missbrauch und Abhängigkeit: Entstehung – Folgen – Therapie. Stuttgart; Thieme 2007
    PubMedGoogle Scholar
  • 21 Bayard M, McIntyre J, Hill K R. et al . Alcohol withdrawal syndrome.  Am Fam Physician. 2004;  69 1443-1450
    PubMedGoogle Scholar
  • 22 Soyka M, Lutz W, Kauert G. et al . Epileptische Anfälle im Alkoholentzug.  Psycho. 1989;  15 244-255
    PubMedGoogle Scholar
  • 23 McKeon A, Frye M A, Delanty N. The alcohol withdrawal syndrome.  J Neurol Neurosurg Psychiatry. 2008;  79 854-862
    CrossrefPubMedGoogle Scholar
  • 24 Tartara A, Manni R, Mazzella G. Epileptic seizures and alcoholism. Clinical and pathogenetic aspects.  Acta Neurol Belg. 1983;  83 88-94
    PubMedGoogle Scholar
  • 25 Leitlinie für Diagnostik und Therapie in der Neurologie; 3. überarbeitete Auflage. Stuttgart; Thieme 2005
    Google Scholar
  • 26 Soyka M, Schmidt F, Schmidt P. Efficacy and safety of outpatient alcohol detoxification with a combination of tiapride / carbamazepine: additional evidence.  Pharmacopsychiatry. 2006;  39 30-34
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Mundle G, Banger M, Mugele F. et al .Alkoholbezogene Störungen, Akutbehandlung. In: Schmidt LG, Gastpar M, Falkai P, Gaebel W Evidenzbasierte Suchtmedizin. Köln; Deutscher Ärzte-Verlag 2006: 25-52
    PubMedGoogle Scholar
  • 28 Cook C C, Thomson A D. B-complex vitamins in the prophylaxis and treatment of Wernicke-Korsakoff syndrome.  Br J Hosp Med. 1997;  57 461-465
    PubMedGoogle Scholar
  • 29 Cross A J, Stirling J M, Robinson T N. et al . The modulation by chlormethiazole of the GABAA-receptor complex in rat brain.  Br J Pharmacol. 1989;  98 284-290
    PubMedGoogle Scholar
  • 30 Pentikainen P J, Neuvonen P J, Tarpila S. et al . Effect of cirrhosis of the liver on the pharmacokinetics of chlormethiazole.  Br Med J. 1978;  23 861-863
    PubMedGoogle Scholar
  • 31 Morgan M Y. The management of alcohol withdrawal using chlormethiazole.  Alcohol Alcohol. 1995;  30 771-774
    PubMedGoogle Scholar
  • 32 Hillemacher T, Weinland C, Heberlein A. et al . Treatment with clomethiazole is associated with lower rates of premature discharge during alcohol withdrawal.  Pharmacopsychiatry. 2008;  41 134-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Holbrook A M, Crowther R, Lotter A. et al . Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal.  Can Med Assoc J. 1999;  160 649-655
    PubMedGoogle Scholar
  • 34 Amato L, Minozzi S, Vecchi S. et al . Benzodiazepines for alcohol withdrawal.  Cochrane Database Syst Rev. 2010;  3 , CD005063
    PubMedGoogle Scholar
  • 35 Ntais C, Pakos E, Kyzas P. et al . Benzodiazepines for alcohol withdrawal.  Cochrane Database Syst Rev. 2005;  20 , CD005063
    PubMedGoogle Scholar
  • 36 Bird R D, Makela E H. Alcohol withdrawal: what is the benzodiazepine of choice?.  Ann Pharmacother. 1994;  28 67-71
    PubMedGoogle Scholar
  • 37 Solomon J, Rouck L A, Koepke H H. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome.  Clin Ther. 1983;  6 52-58
    PubMedGoogle Scholar
  • 38 Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on symptoms and cognitive recovery.  Drug Alcohol Depend. 1986;  18 329-334
    CrossrefPubMedGoogle Scholar
  • 39 Holzbach R. Benzodiazepinabhängigkeit.  Abhängigkeiten. 2000;  2 5-16
    PubMedGoogle Scholar
  • 40 Holzbach R. Weiter verschreiben oder stoppen? Die Langzeiteinnahme von Benzodiazepinen.  Der Neurologe, Psychiater. 2005;  10 45-47
    PubMedGoogle Scholar
  • 41 Saitz R, Mayo-Smith M F, Roberts M S. et al . Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial.  JAMA. 1994;  272 519-523
    CrossrefPubMedGoogle Scholar
  • 42 Hodges B, Mazur J E. Intravenous ethanol for the treatment of alcohol withdrawal syndrome in critically ill patients.  Pharmacotherapy. 2004;  24 1578-1585
    CrossrefPubMedGoogle Scholar
  • 43 Peters D H, Faulds D. Tiapride. A review of its pharmacology and therapeutic potential in the management of alcohol dependence syndrome.  Drugs. 1994;  47 1010-1032
    CrossrefPubMedGoogle Scholar
  • 44 Lucht M, Kuehn K U, Armbruster J. et al . Alcohol withdrawal treatment in intoxicated vs non-intoxicated patients: a controlled open-label study with tiapride / carbamazepine, clomethiazole and diazepam.  Alcohol Alcohol. 2003;  38 168-175
    PubMedGoogle Scholar
  • 45 Kraus M L, Gottlieb L D, Horwitz R I. et al . Randomized clinical trial of atenolol in patients with alcohol withdrawal.  N Engl J Med. 1985;  313 905-909
    CrossrefPubMedGoogle Scholar
  • 46 Sellers E M, Zilm D H, Degani N C. Comparative efficacy of propranolol and chlordiazepoxide in alcohol withdrawal.  J Stud Alcohol. 1977;  38 2096-2108
    PubMedGoogle Scholar
  • 47 Björkqvist S E. Clonidine in alcohol withdrawal.  Acta psychiatr Scand. 1975;  52 256-263
    CrossrefPubMedGoogle Scholar
  • 48 Wilkins A J, Jenkins W J, Steiner J A. Efficacy of clonidine in treatment of alcohol withdrawal state.  Psychopharmacology (Berl). 1983;  81 78-80
    CrossrefPubMedGoogle Scholar
  • 49 Björkqvist S E, Isohanni M, Mäkelä R. et al . Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: a formal multicentre doubl-blind comparison with placebo.  Acta psychiatr Scand. 1976;  53 333-342
    CrossrefPubMedGoogle Scholar
  • 50 Bonnet U, Schäfer M, Richter C. et al . Antikonvulsiva in der Behandlung der Alkoholabhängigkeit.  Fortschr Neurol Psychiatr. 2009;  77 192-202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Malcolm R, Myrick H, Roberts J. et al . The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial.  J Gen Intern Med. 2002;  17 349-355
    CrossrefPubMedGoogle Scholar
  • 52 Schik G, Wedegaertner F R, Liersch J. et al . Oxcarbazepine versus carbamazepine in the treatment of alcohol withdrawal.  Addict Biol. 2005;  10 283-288
    CrossrefPubMedGoogle Scholar
  • 53 Koethe D, Juelicher A, Nolden B M. et al . Oxcarbazepine – efficacy and tolerability during treatment of alcohol withdrawal: a double-blind, randomized, placebo-controlled multicenter pilot study.  Alcohol Clin Exp Res. 2007;  31 1188-1194
    CrossrefPubMedGoogle Scholar
  • 54 Minozzi S, Amato L, Vecchi S. et al . Anticonvulsants for alcohol withdrawal.  Cochrane Database Syst Rev. 2010;  3 , CD005064
    PubMedGoogle Scholar
  • 55 Krupitsky E M, Rudenko A A, Burakov A M. et al . Antiglutamatergic strategies for ethanol detoxification: comparison with placebo and diazepam.  Alcohol Clin Exp Res. 2007;  31 604-611
    PubMedGoogle Scholar
  • 56 Addolorato G, Leggio L, Abenavoli L. et al . Baclofen in the treatment of alcohol withdrawal syndrome: a comparative study vs diazepam.  Am J Med. 2006;  119 e13-18
    PubMedGoogle Scholar
  • 57 Stallings W, Schrader S. Baclofen as prophylaxis and treatment for alcohol withdrawal: a retrospective chart review.  J Okla State Med Assoc. 2007;  100 354-360
    PubMedGoogle Scholar
  • 58 O'Connor A B, Lang V J. Baclofen not comparable to diazepam for alcohol withdrawal.  Am J Med. 2007;  120 e5
    PubMedGoogle Scholar
  • 59 Saitz R. Baclofen for alcohol withdrawal: not comparable to the gold standard (benzodiazepines).  Am J Med. 2007;  120 e9
    PubMedGoogle Scholar
  • 60 Leone M A, Vigna-Taglianti F, Avanzi G. et al . Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses.  Cochrane Database Syst Rev. 2010;  2 , CD006266
    PubMedGoogle Scholar
  • 61 Meagher D J. Delirium: optimising management.  Br Med J. 2001;  322 144-149
    CrossrefPubMedGoogle Scholar
  • 62 Mayo-Smith M F, Beecher L H, Fischer T L. et al., Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine . Management of alcohol withdrawal delirium. An evidence-based practice guideline.  Arch Intern Med. 2004;  164 1405-1412
    CrossrefPubMedGoogle Scholar
  • 63 Mayo-Smith M F. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal . Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline.   JAMA. 1997;  278 144-151
    Google Scholar
  • 64 Caspari D, Wappler M, Bellaire W. Treatment of delirium tremens – a comparison between clomethiazole and clorazepate with reference to effectiveness and rate of side effects.  Psychiat Prax. 1992;  19 23-27
    PubMedGoogle Scholar
  • 65 Athen D. Comparative investigation of chlormethiazole and neuroleptic agents in the treatment of alcoholic delirium.  Acta psychiatr Scand Suppl. 1986;  329 167-170
    PubMedGoogle Scholar
  • 66 Feuerlein W, Reiser E. Parameters affecting the course and results of delirium tremens treatment.  Acta psychiatr Scand Suppl. 1986;  329 120-123
    PubMedGoogle Scholar
  • 67 D'Onofrio G, Rathlev N K, Ulrich A S. et al . Lorazepam for the prevention of recurrent seizures related to alcohol.  N Engl J Med. 1999;  340 915-919
    CrossrefPubMedGoogle Scholar
  • 68 Chance J F. Emergency department treatment of alcohol withdrawal seizures with phenytoin.  Ann Emerg Med. 1991;  20 520-522
    CrossrefPubMedGoogle Scholar
  • 69 Rathlev N K, D'Onofrio G, Fish S S. et al . The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures.  Ann Emerg Med. 1994;  23 513-518
    CrossrefPubMedGoogle Scholar
  • 70 Alldredge B K, Lowenstein D H. Status epilepticus related to alcohol abuse.  Epilepsia. 1993;  34 1033-1037
    CrossrefPubMedGoogle Scholar
  • 71 Hauser W A, Ng S K, Brust J C. Alcohol, seizures, and epilepsy.  Epilepsia. 1988;  29 (Suppl. 2) S66-78
    CrossrefPubMedGoogle Scholar
  • 72 MacDonald B K, Johnson A L, Goodridge D M. et al . Factors predicting prognosis of epilepsy after presentation with seizures.  Ann Neurol. 2000;  48 833-841
    CrossrefPubMedGoogle Scholar
  • 73 Rathlev N K, Ulrich A, Shieh T C. et al . Etiology and weekly occurrence of alcohol-related seizures.  Acad Emerg Med. 2002;  9 824-828
    CrossrefPubMedGoogle Scholar
  • 74 Berg A T, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review.  Neurology. 1991;  41 965-972
    CrossrefPubMedGoogle Scholar
  • 75 Hillbom M E, Hjelm-Jäger M. Should alcohol withdrawal seizures be treated with anti-epileptic drugs?.  Acta Neurol Scand. 1984;  69 39-42
    CrossrefPubMedGoogle Scholar
  • 76 Mihai A, Damsa C, Allen M. et al . Viewing videotape of themselves while experiencing delirium tremens could reduce the relapse rate in alcohol-dependent patients.  Addiction. 2007;  102 226-231
    CrossrefPubMedGoogle Scholar
  • 77 Bühringer G, Hoch E. Viewing videotapes of one's own delirium tremens: renaissance of alcohol dependence as ,disease of the will‘?.  Addiction. 2007;  102 183-184
    CrossrefPubMedGoogle Scholar
  • 78 Polcin D L. Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context.  Subst Use Misuse. 2003;  38 165-184
    CrossrefPubMedGoogle Scholar
  • 79 Miller W R, Benefield R G, Tonigan J S. Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles.  J Consult Clin Psychol. 1993;  61 178-183
    PubMedGoogle Scholar
  • 80 Miller W R. Rediscovering fire: small interventions, large effects.  Psychol Addict Behav. 2000;  14 6-18
    CrossrefPubMedGoogle Scholar

Dr. med. Ulrich C. Lutz

Universitätsklinik für Psychiatrie und Psychotherapie

Osianderstraße 24

72076 Tübingen

Email: Ulrich.Lutz@med.uni-tuebingen.de