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July 25, 1977

Withdrawal From Diazepam

Author Affiliations

Psychiatric Institute New York

JAMA. 1977;238(4):306. doi:10.1001/jama.1977.03280040026012

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To the Editor.—  Arthur Ecker, MD, commented (237:765, 1977) on our letter (236:2172, 1976) on grand mal convulsions, which we ascribed to abrupt withdrawal from diazepam; he postulated an alternative diagnosis of stress convulsions. The reference he provided to this condition (Arch Neurol 31:155-159, 1974) defined it as epileptic attacks in persons who have not previously had unprovoked epileptic attacks, and who during the period immediately prior to the attack were exposed to stress such as lack of sleep, emotional stress, or somatic or intellectual overexertion. Convulsions owing to alcohol or drug abuse were excluded. Thus, by definition our patient would not receive such a diagnosis if one believes that the exposure to diazepam was drug abuse; conversely, the definition would fit if our assumption was otherwise. It is not crucial for our point, but according to our ability to discriminate, the patient was not under unusual stress. The two