Background Benzodiazepines (BDZ) are a class of psychoactive drugs that have been widely used for the treatment of many medical conditions. In this paper, a case of an atypical pattern of diazepam dependence in a patient with epilepsy is presented. The article may be an interesting proposition for rational management in the treatment of benzodiazepine dependence in a patient with non-withdrawal and withdrawal seizures. Detoxification is used then to optimize neurological treatment. Case presentation A 52-year-old Caucasian male, diagnosed with epilepsy with partial complex, and rarely tonic-clonic seizures and benzodiazepine (diazepam) misuse, was admitted to a detoxification unit specialized to treat substance dependence. This patient presented an atypical schedule of substance misuse with a weekly dose of 40 to 45 mg of diazepam, taken once a week, every Saturday. The patient reported having a group of symptoms that usually preceded generalized seizures that were described as the “aura” manifesting as confusion, derealisation, anxiety, and difficulties in speaking. First Saturday after admission to the hospital, the first aura experience was reported, while diazepam level in serum was higher than usual, which was supporting also strong psychological background for withdrawal. On weekend days, 3 weeks after admission, when the patient was receiving 3 mg of diazepam daily, he developed a severe “aura.” The EEG showed no seizure activity. Two weeks later (again Friday to Saturday), the patient reported the occurrence of aura, the EEG recording showed paroxysmal discharges, generalized multiple spikes associated with slow waves, lasting about 30 s, accompanied by eyelid myoclonia and disturbed consciousness. A week later another aura developed that resolved spontaneously without a seizure. Twelve days later, diazepam was completely removed; the elimination of serum benzodiazepines took place. The patient did not report aura until the end of the stay and he was dismissed 5 weeks later. Conclusions The differential diagnosis of an aura can be challenging. Carefully proceed serum monitored elimination of benzodiazepines in epileptic patients may serve in safety benefits and helps to achieve detoxification goals. Hence, it is important to prevent, recognize, and treat benzodiazepine dependence in every patient and may improve epilepsy treatment outcome.

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癫痫患者非典型苯二氮卓类药物滥用和戒断病例报告

背景苯二氮卓类药物 (BDZ) 是一类精神活性药物，已广泛用于治疗多种疾病。在本文中，介绍了一个癫痫患者非典型地西泮依赖模式的案例。这篇文章可能是对非戒断性和戒断性癫痫患者的苯二氮卓依赖治疗进行合理管理的有趣提议。然后使用解毒来优化神经治疗。病例介绍 一名 52 岁的白人男性被诊断患有部分复杂性癫痫，很少出现强直阵挛发作和苯二氮卓（地西泮）滥用，被收治到专门治疗物质依赖的戒毒单位。该患者表现出非典型的物质滥用时间表，每周服用 40 至 45 毫克地西泮，每周一次，每周六。患者报告有一组通常先于全身性癫痫发作的症状，这些症状被描述为“先兆”，表现为意识模糊、现实感丧失、焦虑和说话困难。入院后的第一个星期六，报告了第一次先兆体验，而血清中地西泮水平高于平时，这也支持了强烈的戒断心理背景。在周末，即入院后 3 周，当患者每天接受 3 毫克地西泮时，他出现了严重的“先兆”。脑电图显示没有癫痫发作活动。两周后（又是周五到周六），患者报告先兆发生，脑电图记录显示阵发性放电，全身多发尖峰伴慢波，持续约30s，伴有眼睑肌阵挛和意识障碍。一周后，另一种先兆出现，可自发消退，没有癫痫发作。12天后，地西泮被完全去除；消除了血清苯二氮卓类药物。患者直到住院结束才报告先兆，并在 5 周后被解雇。结论 先兆的鉴别诊断可能具有挑战性。在癫痫患者中仔细进行血清监测的苯二氮卓类药物的消除可能会带来安全益处并有助于实现解毒目标。因此，预防、识别和治疗每位患者的苯二氮卓依赖很重要，并可能改善癫痫治疗结果。地西泮被完全去除；消除了血清苯二氮卓类药物。患者直到住院结束才报告先兆，并在 5 周后被解雇。结论先兆的鉴别诊断可能具有挑战性。在癫痫患者中仔细进行血清监测的苯二氮卓类药物的消除可能会带来安全益处并有助于实现解毒目标。因此，预防、识别和治疗每位患者的苯二氮卓依赖很重要，并可能改善癫痫治疗结果。地西泮被完全去除；消除了血清苯二氮卓类药物。患者直到住院结束才报告先兆，并在 5 周后被解雇。结论先兆的鉴别诊断可能具有挑战性。在癫痫患者中仔细进行血清监测的苯二氮卓类药物的消除可能会带来安全益处并有助于实现解毒目标。因此，预防、识别和治疗每位患者的苯二氮卓依赖很重要，并可能改善癫痫治疗结果。在癫痫患者中仔细进行血清监测的苯二氮卓类药物的消除可能会带来安全益处并有助于实现解毒目标。因此，预防、识别和治疗每位患者的苯二氮卓依赖很重要，并可能改善癫痫治疗结果。在癫痫患者中仔细进行血清监测的苯二氮卓类药物的消除可能会带来安全益处并有助于实现解毒目标。因此，预防、识别和治疗每位患者的苯二氮卓依赖很重要，并可能改善癫痫治疗结果。