Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report
Abstract Background Benzodiazepines (BDZ) are a class of psychoactive drugs that have been widely used for the treatment of many medical conditions. In this paper, a case of an atypical pattern of diazepam dependence in a patient with epilepsy is presented. The article may be an interesting proposit...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-11-01
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| Series: | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41983-020-00248-2 |
| _version_ | 1819105020584394752 |
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| author | Natalia Piskorska Andrzej Silczuk |
| author_facet | Natalia Piskorska Andrzej Silczuk |
| author_sort | Natalia Piskorska |
| collection | DOAJ |
| description | Abstract Background Benzodiazepines (BDZ) are a class of psychoactive drugs that have been widely used for the treatment of many medical conditions. In this paper, a case of an atypical pattern of diazepam dependence in a patient with epilepsy is presented. The article may be an interesting proposition for rational management in the treatment of benzodiazepine dependence in a patient with non-withdrawal and withdrawal seizures. Detoxification is used then to optimize neurological treatment. Case presentation A 52-year-old Caucasian male, diagnosed with epilepsy with partial complex, and rarely tonic-clonic seizures and benzodiazepine (diazepam) misuse, was admitted to a detoxification unit specialized to treat substance dependence. This patient presented an atypical schedule of substance misuse with a weekly dose of 40 to 45 mg of diazepam, taken once a week, every Saturday. The patient reported having a group of symptoms that usually preceded generalized seizures that were described as the “aura” manifesting as confusion, derealisation, anxiety, and difficulties in speaking. First Saturday after admission to the hospital, the first aura experience was reported, while diazepam level in serum was higher than usual, which was supporting also strong psychological background for withdrawal. On weekend days, 3 weeks after admission, when the patient was receiving 3 mg of diazepam daily, he developed a severe “aura.” The EEG showed no seizure activity. Two weeks later (again Friday to Saturday), the patient reported the occurrence of aura, the EEG recording showed paroxysmal discharges, generalized multiple spikes associated with slow waves, lasting about 30 s, accompanied by eyelid myoclonia and disturbed consciousness. A week later another aura developed that resolved spontaneously without a seizure. Twelve days later, diazepam was completely removed; the elimination of serum benzodiazepines took place. The patient did not report aura until the end of the stay and he was dismissed 5 weeks later. Conclusions The differential diagnosis of an aura can be challenging. Carefully proceed serum monitored elimination of benzodiazepines in epileptic patients may serve in safety benefits and helps to achieve detoxification goals. Hence, it is important to prevent, recognize, and treat benzodiazepine dependence in every patient and may improve epilepsy treatment outcome. |
| first_indexed | 2024-12-22T02:15:36Z |
| format | Article |
| id | doaj.art-33a743c1db6a49459753cbec88d8ed75 |
| institution | Directory Open Access Journal |
| issn | 1687-8329 |
| language | English |
| last_indexed | 2024-12-22T02:15:36Z |
| publishDate | 2020-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
| spelling | doaj.art-33a743c1db6a49459753cbec88d8ed752022-12-21T18:42:17ZengSpringerOpenThe Egyptian Journal of Neurology, Psychiatry and Neurosurgery1687-83292020-11-015611310.1186/s41983-020-00248-2Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case reportNatalia Piskorska0Andrzej Silczuk1Department of the Prevention and the Treatment of Addictions, Institute of Psychiatry and NeurologyDepartment of the Prevention and the Treatment of Addictions, Institute of Psychiatry and NeurologyAbstract Background Benzodiazepines (BDZ) are a class of psychoactive drugs that have been widely used for the treatment of many medical conditions. In this paper, a case of an atypical pattern of diazepam dependence in a patient with epilepsy is presented. The article may be an interesting proposition for rational management in the treatment of benzodiazepine dependence in a patient with non-withdrawal and withdrawal seizures. Detoxification is used then to optimize neurological treatment. Case presentation A 52-year-old Caucasian male, diagnosed with epilepsy with partial complex, and rarely tonic-clonic seizures and benzodiazepine (diazepam) misuse, was admitted to a detoxification unit specialized to treat substance dependence. This patient presented an atypical schedule of substance misuse with a weekly dose of 40 to 45 mg of diazepam, taken once a week, every Saturday. The patient reported having a group of symptoms that usually preceded generalized seizures that were described as the “aura” manifesting as confusion, derealisation, anxiety, and difficulties in speaking. First Saturday after admission to the hospital, the first aura experience was reported, while diazepam level in serum was higher than usual, which was supporting also strong psychological background for withdrawal. On weekend days, 3 weeks after admission, when the patient was receiving 3 mg of diazepam daily, he developed a severe “aura.” The EEG showed no seizure activity. Two weeks later (again Friday to Saturday), the patient reported the occurrence of aura, the EEG recording showed paroxysmal discharges, generalized multiple spikes associated with slow waves, lasting about 30 s, accompanied by eyelid myoclonia and disturbed consciousness. A week later another aura developed that resolved spontaneously without a seizure. Twelve days later, diazepam was completely removed; the elimination of serum benzodiazepines took place. The patient did not report aura until the end of the stay and he was dismissed 5 weeks later. Conclusions The differential diagnosis of an aura can be challenging. Carefully proceed serum monitored elimination of benzodiazepines in epileptic patients may serve in safety benefits and helps to achieve detoxification goals. Hence, it is important to prevent, recognize, and treat benzodiazepine dependence in every patient and may improve epilepsy treatment outcome.http://link.springer.com/article/10.1186/s41983-020-00248-2EpilepsyBenzodiazepinesWithdrawal syndromeSeizuresCase-study report |
| spellingShingle | Natalia Piskorska Andrzej Silczuk Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report The Egyptian Journal of Neurology, Psychiatry and Neurosurgery Epilepsy Benzodiazepines Withdrawal syndrome Seizures Case-study report |
| title | Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report |
| title_full | Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report |
| title_fullStr | Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report |
| title_full_unstemmed | Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report |
| title_short | Atypical benzodiazepine misuse and withdrawal in patient with epilepsy: a case report |
| title_sort | atypical benzodiazepine misuse and withdrawal in patient with epilepsy a case report |
| topic | Epilepsy Benzodiazepines Withdrawal syndrome Seizures Case-study report |
| url | http://link.springer.com/article/10.1186/s41983-020-00248-2 |
| work_keys_str_mv | AT nataliapiskorska atypicalbenzodiazepinemisuseandwithdrawalinpatientwithepilepsyacasereport AT andrzejsilczuk atypicalbenzodiazepinemisuseandwithdrawalinpatientwithepilepsyacasereport |