Development of a rating scale for quantitative measurement of the alcohol withdrawal syndrome

Banger, Markus; Philipp, Michael; Herth, T.; Hebenstreit, M.; Aldenhoff, Josef B.

doi:10.1007/bf02190260

Cited by 48 publications

(25 citation statements)

References 15 publications

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“…All participants were diagnosed with alcohol dependency according to and were included in the study on admission for alcohol detoxification. Patients were mainly detoxified with clomethiazole following a symptom-triggered regime using the Banger-Score (Banger, Philipp, Herth, Hebenstreit, & Aldenhoff, 1992). If, for clinical reasons, clomethiazole could not be used, benzodiazepines were administered.…”

Section: Patientsmentioning

confidence: 99%

Alcohol abuse and cigarette smoking are associated with global DNA hypermethylation: Results from the German Investigation on Neurobiology in Alcoholism (GINA)

Semmler

Heese

Stoffel‐Wagner

et al. 2015

Alcohol

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Recent studies have shown that smoking and alcoholism may be associated with altered DNA methylation and that alcohol consumption might induce changes in DNA methylation by altering homocysteine metabolism. In this monocenter study, we included 363 consecutive patients referred for hospitalization for alcohol detoxification treatment. Blood samples were obtained on treatment days 1, 3, and 7 for measurement of global DNA methylation in leukocytes by liquid chromatography tandem mass spectrometry. Genomic DNA was used for genotyping the following seven genetic variants of homocysteine metabolism: cystathionine beta-synthase (CBS) c. This suggests a direct effect of alcohol consumption and smoking on DNA methylation, which is not mediated by effects of alcohol on homocysteine metabolism.

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Section: Patientsmentioning

confidence: 99%

Alcohol abuse and cigarette smoking are associated with global DNA hypermethylation: Results from the German Investigation on Neurobiology in Alcoholism (GINA)

Semmler

Heese

Stoffel‐Wagner

et al. 2015

Alcohol

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“…The symptom-triggered amount of CLO needed to limit AWS within the first 24 hours after its onset was found to be related to the severity of AWS in previous studies. 3,18,19 This means that the stronger the syndrome, the more capsules of CLO are needed to dampen the syndrome within 24 hours. Therefore, this amount of CLO can be used as an indirect measure of the severity of an acute AWS.…”

mentioning

confidence: 97%

“…Therefore, this amount of CLO can be used as an indirect measure of the severity of an acute AWS. 3,18,19 If GP would be strikingly efficacious in the treatment of AWS, it would be superior to P in saving the amount of CLO required to limit AWS.…”

mentioning

confidence: 98%

Treatment of Acute Alcohol Withdrawal With Gabapentin: Results From a Controlled Two-Center Trial

Bonnet¹,

Banger²,

Leweke³

et al. 2003

Journal of Clinical Psychopharmacology

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A few case reports and data from animal experiments point to a possible efficacy of gabapentin (GP) in the treatment of alcohol withdrawal syndrome (AWS). Because of ethical considerations, the efficacy of GP in acute AWS was tested in an add-on fashion to clomethiazole (CLO). Given that the symptom-triggered amount of CLO required to limit AWS within the first 24 hours is related to the severity of AWS, we tested this amount of CLO during placebo (P) or GP (400 mg qid) under double blind, randomized conditions. Sixty-one patients (P = 29/GP = 32) suffering from alcohol dependence (ICD-10) and without any other psychiatric condition or psychotropic medication were included. The groups were not significantly different in baseline characteristics (eg, demographic data, severity of AWS). Both ITT and completer analyses revealed no significant differences between the groups considering the primary effectiveness measure: amount of CLO required in the first 24 hours (P = 6.1 +/- 5.4/GP = 6.2 +/- 4.7 capsules). In addition, premature discontinuations (P = 3/GP = 2) and decreases in Mainz Alcohol Withdrawal Scores were not significantly different in the first 48 hours of AWS (secondary effectiveness measures). Tolerability of combined CLO/GP was studied throughout the whole treatment comprising a 5-day lasting reduction part subsequent to the first 48 hours. Throughout the whole 7-day treatment a total of 5 and 2 patients dropped out and 6 and 5 patients reported adverse clinical events in the P and GP groups, respectively. All together, GP (400 mg qid) was no better than P in saving initial consumption of CLO or decreasing initial Mainz Alcohol Withdrawal Scores suggesting that GP was ineffective in the management of acute AWS in this model. The combination of GP and CLO was safe.

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“…Due to the retrospective nature of this survey and the comprehensive character of the withdrawal symptom scale used, all degrees of severity of the AWS from no or mild autonomic symptomatology to full-blown delirium tremens and/or manifestation of withdrawal seizures were covered. In previous prospective studies, patients with seizures in history had been excluded [10,19]. As a matter of fact, patients with a history of alcohol withdrawal seizures seem to be at higher risk for the development of seizures within future detoxifications [25].…”

Section: Discussionmentioning

confidence: 99%

“…The most widely applied and therefore best validated scale to date is the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-A) [8] and its revised form, the CIWA-Ar [9], both developed for nurse rating. More recent assessment instruments have been proposed by Banger et al [10] providing a physician rating instrument, or by Wetterling et al [11] who assessed somatic and mental subsyndromes on separate scales.…”

Section: Introductionmentioning

confidence: 99%

Symptom-Triggered versus Standard Chlormethiazole Treatment of Inpatient Alcohol Withdrawal: Clinical Implications from a Chart Analysis

Lange-Asschenfeldt¹,

Müller²,

Szegedi³

et al. 2003

Eur Addict Res

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To evaluate clinical effectiveness and safety of 2 different detoxification treatment protocols, a chart analysis of hospital inpatients consecutively admitted for alcohol withdrawal during one year was undertaken. Records of 33 patients receiving symptom-triggered treatment (using a modified version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale) were compared with those of patients treated by applying a fixed-dose regimen (n = 32). Patients (45.3 ± 9.8 years, 21% female) of both groups were comparable regarding illness severity, epidemiologic parameters as well as complications during the observed treatment period. Under symptom-triggered therapy, chlormethiazole (CMZ) treatment duration (4.2 ± 3.5 vs. 7.5 ± 3.3 days, Mann-Whitney U test: p = 0.0003) and cumulative CMZ dosage (4,352 ± 4,589 vs. 9,921 ± 6,599 mg, Mann-Whitney U test: p = 0.0004) were significantly reduced. The daily CMZ dose was significantly lower at days 1–5 in the group receiving symptom-triggered treatment. There was no influence of age on the outcome parameters of either treatment group. In conclusion, an individualized symptom-triggered treatment of alcohol withdrawal with CMZ seems to be equally safe but more efficient than a scheduled regimen.

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Development of a rating scale for quantitative measurement of the alcohol withdrawal syndrome

Cited by 48 publications

References 15 publications

Alcohol abuse and cigarette smoking are associated with global DNA hypermethylation: Results from the German Investigation on Neurobiology in Alcoholism (GINA)

Alcohol abuse and cigarette smoking are associated with global DNA hypermethylation: Results from the German Investigation on Neurobiology in Alcoholism (GINA)

Treatment of Acute Alcohol Withdrawal With Gabapentin: Results From a Controlled Two-Center Trial

Symptom-Triggered versus Standard Chlormethiazole Treatment of Inpatient Alcohol Withdrawal: Clinical Implications from a Chart Analysis

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