Plasma homocysteine is a predictor of alcohol withdrawal seizures

An adaptive consequence of prolonged ethanol consumption is a compensatory up-regulation of NMDA receptors in certain brain areas. Taking into account that homocysteine and its breakdown products (i.e. homocysteic acid) are p utative neurotransmitters and agonists at the NMDA receptor, the aim of thi s study was to assess the influence of levels of homocysteine on alcohol wi thdrawal seizures. Six patients with chronic alcoholism who suffered from w ithdrawal seizures had significantly higher levels of homocysteine on admis sion (84.7 +/- 29.8 mu mol/l) than patients (n = 26) who did not develop se izures (30.2 +/- 23.2 mu mol/l; U = 8.0, p = 0.0007). Furthermore, seizure patients had significantly lower levels of folate and significantly higher blood alcohol concentrations. Using a logistic regression analysis, withdra wal seizures were best predicted by a high homocysteine level on admission (P < 0.01; odds ratio = 1.05). Homocysteine levels on admission may be a us eful screening method to identify patients at risk for withdrawal seizures. NeuroReport 11:2749-2752 (C) 2000 Lippincott Williams & Wilkins.