levetiracetam and Substance-Related-Disorders

Zolpidem is an imidazopyridine nonbenzodiazepine hypnotic drug with a high affinity to the α1 subunit of the gamma amino butyric acid A receptor It is the first pharmacological option in the short-term management of sleep-onset insomnia. Initially considered a safer drug compared to benzodiazepines because of lower liability for abuse and dependence, recently, an increasing body of reports has questioned zolpidem's proneness to misuse. In this report, we describe a case of serious zolpidem abuse requiring pharmacological washout during hospitalization because of previous withdrawal seizures in a patient with chronic sleep-onset and maintenance insomnia.

Topics: Aged; Anticonvulsants; Chronic Disease; Clonazepam; Female; Hospitalization; Humans; Levetiracetam; Pregabalin; Seizures; Selective Serotonin Reuptake Inhibitors; Sertraline; Sleep Aids, Pharmaceutical; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Zolpidem

High-dose benzodiazepine (BZD) dependence represents an emerging and under-reported addiction phenomenon and is associated with reduced quality of life. To date there are no guidelines for the treatment of high-dose BZD withdrawal. Low-dose slow flumazenil infusion was reported to be effective for high-dose BZD detoxification, but there is concern about the risk of convulsions during this treatment. We evaluated the occurrence of seizures in 450 consecutive high-dose BZD dependence patients admitted to our unit from April 2012 to April 2016 for detoxification with low-dose slow subcutaneous infusion of flumazenil associated with routine anticonvulsant prophylaxis. In our sample, 22 patients (4.9%) reported history of convulsions when previously attempting BZD withdrawal. Only four patients (0.9%) had seizures during ( n = 2) or immediately after ( n = 2) flumazenil infusion. The two patients with seizures during flumazenil infusion were poly-drug misusers. The most common antiepileptic drugs (AEDs) used for anticonvulsant prophylaxis were either valproate 1000 mg or levetiracetam 1000 mg. Our data indicate that, when routinely associated with AEDs prophylaxis, low-dose slow subcutaneous flumazenil infusion represents a safe procedure, with low risk of seizure occurrence.

Topics: Adolescent; Adult; Anti-Anxiety Agents; Anticonvulsants; Antidotes; Benzodiazepines; Female; Flumazenil; Humans; Hypnotics and Sedatives; Levetiracetam; Male; Middle Aged; Piracetam; Quality of Life; Seizures; Substance-Related Disorders; Valproic Acid; Young Adult

Cardiac dysfunction occurring secondary to neurologic disease, termed neurogenic stunned myocardium, is an incompletely understood phenomenon that has been described after several distinct neurologic processes. We present a case of neurogenic stunned myocardium, discovered intraoperatively after anesthetic induction, in a patient who presented to our operating room with a recent intraparenchymal hemorrhage. We discuss the longitudinal cardiac functional course after neurogenic stunned myocardium. Finally, we discuss the pathophysiology of neurogenic stunned myocardium, as well as its implications for anesthesiologists caring for neurosurgical patients.

Topics: Adult; Anesthesia, General; Cerebral Hemorrhage; Emergency Service, Hospital; Heart; Hemangioma, Cavernous, Central Nervous System; Humans; Hypertension; Hypotension; Levetiracetam; Male; Methamphetamine; Myocardial Stunning; Nicardipine; Perioperative Period; Phenylephrine; Piracetam; Seizures; Substance-Related Disorders; Takotsubo Cardiomyopathy

Topics: Anticonvulsants; Benzodiazepines; Brain; Electroencephalography; Humans; Levetiracetam; Male; Middle Aged; Piracetam; Status Epilepticus; Substance-Related Disorders