Alcohol and Alcoholism Advance Access originally published online on September 20, 2004
Alcohol and Alcoholism 2004 39(6):493-498; doi:10.1093/alcalc/agh094
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Alcohol & Alcoholism Vol. 39, No. 6 © Medical Council on Alcohol 2004; all rights reserved
HOMOCYSTEINE LEVELS IN PATIENTS CLASSIFIED ACCORDING TO LESCH'S TYPOLOGY
1 Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen–Nuremberg and 2 Department of Addiction Klinikum am Europakanal, Erlangen, Germany
* Author to whom correspondence should be addressed at: Friedrich-Alexander, University of Erlangen–Nuremberg, Department of Psychiatry and Psychotherapy, Schwabachanlage 6, D-91054 Erlangen, Germany. Tel.: +49 9131 8534597; Fax: +49 9131 8534105; E-mail: stefan.bleich{at}psych.imed.uni-erlangen.de
(Received 13 April 2004; first review notified 25 June 2004; in revised form 30 June 2004; accepted 9 August 2004)
Aims: It has been suggested that elevated total plasma homocysteine levels might be useful to predict alcohol withdrawal seizures. The typology by Lesch distinguishes between four subtypes of which type 1 suffers from marked withdrawal symptoms, including alcohol withdrawal seizures. This study was undertaken to investigate total plasma homocysteine levels in actively drinking patients with alcoholism who were classified according to Lesch's typology. Subjects and methods: We determined total plasma homocysteine levels in 144 non-abstinent chronic alcoholics (115 men, 29 women; aged 22–67 years). Patients were classified in Lesch's typology (LT) and were divided into two groups: LT 1 (n = 27) and LT 2–4 (n = 117). Within the groups, patients with or without a history of alcohol withdrawal seizures were differentiated. Results: All patients with a history of alcohol withdrawal seizures had significantly elevated plasma homocysteine concentrations at admission when compared with those without seizures (Mann–Whitney U, P < 0.001). Furthermore, patients classified as LT 1 who suffered from an alcohol withdrawal seizure (n = 12) had significantly higher plasma homocysteine levels (Z = –2.31, P = 0.02) when compared to the corresponding types 2–4 (n = 24). Using a logistic regression analysis, withdrawal seizures were best predicted by a high homocysteine level at admission but even more pronounced in LT 1 (Wald's chi-squared [
2] = 10.7; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03–1.51; P < 0.001) when compared with LT 2–4 (2 = 10.6; OR 1.06; 95%CI 1.03–1.14; P = 0.004). Conclusion: To our knowledge, this is the first study evaluating homocysteine levels in patients who were classified according to Lesch's typology. Homocysteine levels on admission may be a useful screening method to identify actively drinking patients at risk of alcohol withdrawal seizures, especially in alcoholics with Lesch type 1.
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