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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Seizures and substance abuse

Treatment considerations

From the Department of Neurology, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.

Address correspondence and reprint requests to Prof. John C.M. Brust, Director, Harlem Hospital Neurology Service, Department of Neurology, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, NY 10037; e-mail: jcb2{at}columbia.edu

Seizures often occur in substance abusers. The mechanism may be indirect (CNS infection, cerebral trauma, stroke, metabolic derangement) or direct (intoxication or withdrawal). These mechanisms are not mutually exclusive. A patient with obvious overdose or abstinence symptoms might also have meningitis or an acute subdural hematoma, and a polydrug abuser might be simultaneously intoxicated by one drug while withdrawing from another. Management of such patients often requires much more than simple administration of an anticonvulsant medication. Medical and surgical emergencies must be identified and nonconvulsive signs of intoxication and withdrawal must be addressed. A basic principle in treating drug withdrawal is to use an agent from the same pharmacologic class or one with a degree of cross-tolerance. Long-term anticonvulsant prophylaxis is usually not indicated when drug intoxication or withdrawal is the sole cause of a seizure.

This supplement has been supported through an unrestricted grant from UCB S.A., manufacturers of levetiracetam (Keppra®).

Disclosure: The author reports no conflicts of interest.

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represents the opinions of the authors and is not endorsed by nor does it reflect the views of the American Academy of Neurology, Editorial Board, Editor-in-Chief, or Associate Editors of Neurology.

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