Alcohol Modulation of Extra-synaptic Gamma-aminobutyric Acid Type A Receptors

Arslan, Ayla

doi:10.21533/pen.v4i1.48

Cited by 2 publications

(2 citation statements)

References 75 publications

(98 reference statements)

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“…A small subset of patients with AWS may also experience severe delirium, seizures, and morbidity 3 . The delirium usually begins about 3 days after the appearance of AWS symptoms and lasts between 1 and 8 days (but typically 2 or 3 days) 4–6 . The AWS‐related seizures classically occur between days 2 and 5 of alcohol cessation (12 to 48 h after AWS begins).…”

Section: Introductionmentioning

confidence: 99%

Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study

Carter

Truong

Šíma

et al. 2020

PM&R

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Background Alcohol withdrawal syndrome (AWS) and traumatic brain injury (TBI) present with similar signs and symptoms, yet their treatment strategies differ greatly. AWS treatment includes the Clinical Institute Withdrawal Assessment (CIWA) protocol, which grades withdrawal signs and symptoms. A major purpose of CIWA is to guide the addition and titration of central nervous system (CNS) depressants, most commonly benzodiazepines. Conversely, best practice is to avoid these same CNS depressants in the setting of TBI. Thus, patients with TBI presenting with AWS risk may receive undesirable interventions that could worsen outcome. Objective To describe the relationship of TBI diagnosis with CIWA protocol scores and intervention implementation. Design Retrospective cohort observational study. Setting Single university‐based, level one trauma center. Patients Three hundred seventy‐five patients with head trauma or AWS classification, identified through the trauma center's trauma registry. Interventions CIWA protocol and related medication use. Main Outcome Measures Frequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients' medical records. Results The percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5%(0‐60) in the No TBI group, up to 12.5% (0‐36) in the Mild TBI group, 27.1% (0‐57) in the Moderate TBI group, and 50.0% (14‐77) in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol. Conclusions TBI diagnosis and higher TBI severity level correlate with higher CIWA scores, but neither increased nor decreased benzodiazepine usage was observed. Antipsychotic use did escalate with TBI diagnosis and severity. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrant future study.

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Section: Introductionmentioning

confidence: 99%

Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study

Carter

Truong

Šíma

et al. 2020

PM&R

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“…In the cerebellum's granule cells, this subunit shows very strong expression (Wisden et al, 1992). The δ-GABAARs have higher affinity for GABA, neurosteroids as well as for alcohol (Arslan, 2016;Joshi and Kapur, 2019 and mediate slow, tonic inhibition (Farrant and Nusser, 2005;Hausser and Clark, 1997;Semyanov et al, 2004). Tonic inhibition is a special form of inhibition, which is important for the threshold of action potential generation and thus critical for the neural excitability (reviewed in Arslan, 2015a).…”

Section: Introductionmentioning

confidence: 99%