Les techniques de désintoxication. Essai d'évaluation (1999)

FRANÇAIS :
Dans le cadre de ce travail, nous avons été amenés à nous interroger sur l'efficacité de la méthode de désintoxication la plus fréquemment utilisée en Belgique pour les patients alcooliques. Cette technique repose sur l'administration à doses dégressives de benzodiazépines sur une période d'environ deux semaines. Les évaluations que nous avons pu réaliser ont montré que cette technique protège de manière efficace les patients des manifestations graves du manque. L'étude de la période qui suit directement la désintoxication a toutefois mis en évidence des déficits importants dans des secteurs comme l'architecture du sommeil, la microcirculation cérébrale et les fonctions neuropsychologiques "exécutives". Une stratégie de prévention et de traitement d'un tel syndrome de post-sevrage devrait être développée. (Résumé d'auteur)
ENGLISH :
The detoxification technique most widely used in Belgium for patients with alcohol dependence consists of the administration of decreasing doses of diazepam associated with abundant hydration and 6 group vitamin supplements. This technique is considered to provide excellent security. However, the value of prescribing complementary medications (particularly anticonvulsants) to patients presenting a particular risk of severe complications of withdrawal, such as convulsions and delirium tremens, is a current topic of debate. The authors tried to demonstrate such risk factors during a retrospective study conducted on more than 700 case files: they observed that several factors, primarily the number of previous episodes of detoxification, were associated with an increased risk of complicated withdrawal syndrome. They also observed that administration of diazepam was a sufficient protective factor, even for these "high-risk" patients. The authors also studied the so-called "post-withdrawal' situation in a group of patients who had undergone uncomplicated detoxification, using the techniques of polysomnography and cerebral ima-Ring (HMPAO SPECT). Severe alterations of somnography were observed, as well as decreased perfusion of frontal regions. A detailed neuropsychological assessment confirmed the selective impairment of higher functions conventionally attributed to this region of the brain. (Author' s abstract)