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 putative
neurotransmitters and agonists at the
NMDA receptor, the aim of this study was to assess the influence of levels of
homocysteine on
alcohol withdrawal seizures. Six patients with chronic
alcoholism who suffered from withdrawal
seizures had significantly higher levels of
homocysteine on admission (84.7 +/- 29.8 micromol/l) than patients (n = 26) who did not develop
seizures (30.2 +/- 23.2 micromol/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, withdrawal
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 useful screening method to identify patients at risk for withdrawal
seizures.