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June 22, 1970

Rum Fits and DT's

JAMA. 1970;212(12):2112-2113. doi:10.1001/jama.1970.03170250066016

With the termination of a prolonged drinking bout, alcohol often leaves behind a highly agitated host. Epilepsy and delirium tremens—both manifestations of alcohol withdrawal in a chronic alcoholic— bequeath to the victim harrowing memories and to the attending physician a clearly etched clinical picture. Characterized by one or several grand mal seizures, without any associated abnormalities in the electroencephalogram, alcohol epilepsy appears within 6-48 hours of withdrawal, and in about 30% of the cases it is followed by delirium tremens —a syndrome marked by confusion, tremor, insomnia, hallucinations, delusions, and overactivity of the autonomic nervous system evidenced by dilated pupils, tachycardia, fever, and sweating. Patients manifesting withdrawal symptoms show remarkable sensitivity to photic stimuli, to which they respond with myoclonic movements or generalized convulsions. Obviously, the central nervous system is in a hyperexcitable state, variously attributed to pyridoxine deficiency, adrenocortical hyposecretion, or reduced cerebral oxidative metabolism.

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