Lamotrigine augmentation in delirium tremens.

Abstract

Delirium tremens (DT) is most severe neurological complication of alcohol withdrawal with high mortality rate. DT is related to an altered balance of excitatory and inhibitory amino-acid neurotransmitters, which is basically due to upregulation of glutaminergic neurotransmission induced by chronic ethanol exposure. Lamotrigine (LTG) is believed to act by reducing excitatory glutamate release due to inhibition of Na (+) channels. The aim of this study was to investigate efficiency of the LTG therapy in the treatment of delirium tremens. This prospective clinical study included 240 patients with ICD-10 criteria for DT, who were randomly divided into control and experimental group. The patients were observed within 28 days at the Intensive Care Unit of the Centre for Urgent Psychiatric disorders, according to a specific protocol, which included CIWA-Ar and MDAS clinical scales. Control and experimental group were treated according to the NIAAA protocol for 2004, and experimental group with adding of LTG according to a specific program. CIWA and MDAS scores in the experimental and control group has statistical significant differences after the third day (p > 0.1), and especially after the fifth day (ECIWA5/KCIWA5 = 8.36 +/- 6.782/32 +/- 5.562; EMDAS5/KMDAS5 = 4.89 +/- 3.408/26.33 +/- 1.497) (p > 0.5). LTG is significantly efficient in the treatment of delirium tremens, but it does not decrease mortality rate.