pileptiform Convulsive Disorder Under Chronic Meprobamate Intoxication

Abstract

The present author has studied from various viewpoint 14 patients who had epileptiform convulsive disorders under choronic Meprobamate intoxication and 47 additional cases which were already reported in Japanese and other languages.
1) There were no specific convulsive predi sposition and family history in the author's cases. Remarkable personality disorder of these cases were often seen in the peoples who addicted any drugs and others. They had no intellectual defect.
2) Generally, convulsive seizure broke out when one took Meprobamate more than 3g daily over one to several years.
3) In the literature, ev ery other author understood that these convulsive seizures had occured only as abstinence syndrom. It is certain that the majorities of these convulsions occur as abstinence syndrom but others occur during the intake of this drug. Delirium or disturbance of alertness also would develop likeweise. The present author differentiated four types regardig to the occurrence of convulsive seizure as well as the intake of this drug. A: Convulsion precipitated by abrupt withdrawal. B: Convulsion which occured during intake of this drug. C: Convulsion which occured under marked consciousness disturbance. D: Convulsion which occured particularly during the treatment of marked consiousness disturbance. Clinical types mentioned above were not always same in one patient.
4) A lmost all the convulsive seizures appeared to be of epileptic nature but they often came out in the form of status epilepticus.
5) Neurological signs and s ymptoms such as fever, nausea, vomiting, shaking and ataxia would frequently accompanied convulsions.
6) Before and after convulsion, the r e was stormy consciousness disturbance which was certainly different from initial and postical twilight state. Convulsive seizures associated with fever and neurological symptoms and severe consciousness disturbance tend to have the form of status epilepticus. Therefore these signs and symtoms suggest some serious oragnic brain damage. In this regard, the present author discovered in the literatures three cases, of whom two died during status epilepticus and the other got into comatose with fever from delirium.
7) EEG finding s showed convulsive readiness under Meprobamate abuse, so it is quite natural that the convulsive seizure appears even under its abuse. Moreover, some focal signs in EEG suggest localized damage.
8) It was not effective to gi ve Meprobamate for the treatment of abstinence syndrome. When, once convulsion and related disorder happened to occur, such disorders would reoccur short after re-use of Meprobamate. However, if a patient does not fall in abuse again, another convulsive disorder does not occur and clinical outcome is very favourable, so that it is not necessary to prolong anticonvulsant medication. These convulsive disorders do not look over as accidental outbursts in the patient with convulsive predisposition or as rebound phenomena after long abuse of Meprobamate that has mild anticonvulsant action.