Letter to the Editor

Alcohol abuse is more likely than vitamin-B6 deficiency as a cause of new-onset seizures

Abstract

Of interest is the article by Nathan et al. on a 76-year-old man with new-onset symptomatic seizures attributed to vitamin-B6 deficiency presumably caused by long-term treatment with levodopa/carbidopa (1250mg/250mg) for Parkinson’s disease (PD) [1]. The seizures were classified as refractory as levetiracetam, lacosamide, clobazam and clonazepam were only partially effective [1]. The seizures did not stop earlier than after vitamin B6 supplementation [1]. Some ambiguities should be clarified. Firstly, chronic alcohol abuse was not sufficiently ruled out as a cause of the seizures. Since the patient regularly consumed 2-3 drinks per day and alcohol is one of the most common triggers of seizures, it is likely that the alcohol abuse and not the vitamin B6-deficiency triggered the seizures. Was serum alcohol measured on admission? Were there stigmata of chronic alcoholism such as elevated MCV, elevated GGT or vitamin B12 deficiency? Is it conceivable that the seizures stopped during hospitalization because the patient was no longer allowed to drink? Is it conceivable that the PD worsened 6 months prior to admission due to alcohol abuse? Alcohol is known to aggravate PD [2]. It should have been mentioned in the case description that the patient drank alcohol regularly.