Because of the effects that alcohol has on the body and on behaviour, governments often regulate its use. See below to browse the consumption of alcoholic beverages by country. Alcoholic beverages include wine s, beer s, and spirits. In beers the alcohol content varies from as little as 2 percent to as much as 8 percent; most lager- or ale-type beers contain between 4 and 5 percent.
Natural or unfortified wines such as burgundy , Chianti, and chardonnay usually contain between 8 and 12 percent alcohol, though some varieties have a somewhat higher content, ranging from 12 to 14 percent. Spirits, including vodka , rum , and whiskey , usually contain between 40 and 50 percent alcohol. A standard drink served in most bars contains 0.
Efficacy and Neuropsychological Effects in Alcohol Use Disorders
This finding is consistent with those previously reported for topiramate treatment of alcohol-dependent subjects. Significant differences were not found in comparisons of GGT concentrations obtained for either the zonisamide or the levetiracetam groups with those obtained for the placebo group. For the zonisamide group, in the present study, the value of using GGT as a biomarker for alcohol consumption is limited because mean concentrations of this enzyme, in contrast to those obtained for the other groups, were well within the normal range at screening.
The present study seems to be the first investigation in which the effects of either topiramate or zonisamide on cognitive function in individuals with AD were assessed using a full battery of neuropsychological tests. Treatment with either topiramate or zonisamide was associated with increased difficulty with verbal fluency and verbal working memory.
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In the present study, impairment of visual memory was detected in the topiramate but not the zonisamide group. There was, however, a trend for toward decreased performance on the Trail Making Test Part B, which may also assess aspects of executive function. Executive functioning, however, as measured by the WCST and the interference and color-word portions of the Stroop test was not impaired by this drug.
Results for the mental slowing subscale indicated that mental slowing was found to be worsened only by the administration of topiramate. Moreover, the SLICE effects analysis showed scores elevated above placebo group levels only for the topiramate group for both the memory and total scale scores for the Neurotoxicity Scale in the final 2 weeks of the maintenance therapy phase of the study. These results suggest that topiramate may have adverse neuropsychological effects in subjects with AUDS that are not detected by the cognitive tests used in the present study. In contrast to treatment with either zonisamide or topiramate, levetiracetam administration did not produce any decrements in the performance on the neuropsychological tests used in this study.
This result is consistent with other studies that have shown that levetiracetam treatment is not associated with cognitive impairment in patients with seizure disorder. In the present study, total OCDS scores for the topiramate group became lower during the treatment period than for the placebo group. This is consistent with other findings that topiramate administration may significantly reduce craving for alcohol as measured by the OCDS in subjects with AD, 2,57 although this was not found in a study in which this anticonvulsant was received for only 4 weeks.
Nevertheless, as can be seen in Figure 3 , mean values for total OCDS scores for subjects in the zonisamide and levetiracetam groups seem to decline below levels reached by the subjects in the placebo group. Failure to detect significant differences in scores obtained for the OCDS between placebo and either the zonisamide or the levetiracetam group, therefore, might be related to the small size of these groups in the present study.
The neuronal mechanisms through which topiramate and zonisamide act to produce reductions in alcohol consumption in AD remain to be fully elucidated. The sample sizes used in the present study, although sufficient for comparisons between active medication and placebo, were too small to allow for meaningful between active medication group comparisons of the proportion of subjects in these groups who experienced a specific adverse event. In contrast, none of the subjects in the zonisamide reported having symptoms of paresthesia. These results are consistent with previous studies indicating that problems related to the inhibition of carbonic anhydrase are more likely to occur in individuals treated with topiramate than those who have received zonisamide.
The primary limitation of this study is the small number of subjects included in each treatment group, which allows for only efficacy comparisons between active drugs and placebo but is not powered to detect efficacy differences between the study drugs. The target maintenance doses of zonisamide and topiramate were chosen based on previous findings. This dose also had efficacy in reducing alcohol consumption in subjects with AD.
Although a mg maintenance of topiramate was administered in the present study, other investigators report efficacy with and mg daily doses of this drug. At present, there has been, however, no systematic comparison of different doses of either zonisamide or topiramate on alcohol consumption or on cognitive functioning in subjects with AD. The results of this study provide further support that zonisamide has efficacy as a medication that can facilitate reduced drinking in individuals with AD.
This study has provided an initial characterization of precise areas of cognitive functioning that may be impaired by the administration of either topiramate or zonisamide in AD. Both agents seem to have the potential to produce modest deficits in cognitive function in the areas of verbal fluency and working memory.
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Evaluation of patients with the A-B Neurotoxicity Scale indicate that subjects with AUDS experience overall less impairment of cognition when treated with zonisamide than with topiramate, with the latter drug having more pronounced effects on mental slowing. The findings of this study leave unresolved the question of whether zonisamide produces fewer adverse effects related to the inhibition of carbonic anhydrase than does topiramate.
They do, however, point to the value of further investigation of the many compounds that have been synthesized that are structurally related to these 2 drugs. The authors thank Dr Michael P. LaValley for his very helpful advice pertaining to the statistical analyses used in this article and for his assistance with the randomization of subjects in this study. You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.
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Please try after some time. Received June 13, ; accepted after revision September 18, Back to Top Article Outline. TABLE 1. Topiramate for treating alcohol dependence : a randomized controlled trial. Cited Here Oral topiramate for treatment of alcohol dependence : a randomised controlled trial.
PubMed CrossRef. Improvement of physical health and quality of life of alcohol-dependent individuals with topiramate treatment: US multisite randomized controlled trial. Arch Intern Med. Impaired verbal fluency under topiramate—evidence for synergistic negative effects of epilepsy, topiramate, and polytherapy. Eur J Neurol. Topiramate: effects on cognition in patients with epilepsy, migraine headache and obesity.
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Ther Adv Neurol Disord. Differential cognitive and behavioral effects of topiramate and valproate. A preliminary pharmacogenetic investigation of adverse events from topiramate in heavy drinkers. Exp Clin Psychopharmacol. Metabolic acidosis with topiramate and zonisamide: an assessment of its severity and predictors. Pharmacogenet Genomics. Relationships between plasma concentrations of diphenylhydantoin, phenobarbital, carbamazepine, and 3-sulfamoylmethyl-1,2-benzisoxazole AD , a new anticonvulsant agent, and their anticonvulsant or neurotoxic effects in experimental animals.
Novel, broad-spectrum anticonvulsants containing a sulfamide group: pharmacological properties of S - N -[ 6-chloro-2,3-dihydrobenzo[1,4]dioxinyl methyl]sulfamide JNJ J Med Chem. Structure-activity studies on anticonvulsant sugar sulfamates related to topiramate. Enhanced potency with cyclic sulfate derivatives. Novel, broad-spectrum anticonvulsants containing a sulfamide group: advancement of N - benzo[b]thienyl methyl sulfamide JNJ into human clinical studies. Zonisamide: its pharmacology, efficacy and safety in clinical trials.
Acta Neurol Scand Suppl. Zonisamide for migraine prophylaxis in refractory patients. Epidemiology, risk factors, and treatment of chronic migraine: a focus on topiramate. Zonisamide in the treatment of binge eating disorder with obesity: a randomized controlled trial. J Clin Psychiatry. Zonisamide decreases ethanol intake in rats and mice.
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Pharmacol Biochem Behav. The anticonvulsant zonisamide reduces ethanol self-administration by risky drinkers. Am J Drug Alcohol Abuse. Open label trial of the tolerability and efficacy of zonisamide in the treatment of alcohol dependence. Effects of zonisamide in the treatment of alcohol dependence.
Clin Neuropharmacol. Placebo-controlled trial of zonisamide for the treatment of alcohol dependence. J Clin Psychopharmacol.