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Alcohol is one of the most diffused intoxicating substances in India (and in the whole world). It has traditionally been drunk in tribal societies, although it has won increasing social acceptance among all social groups, urban males being the main example.

Between 15 and 20 per cent of Indian people consume alcohol and, over the past twenty years, the number of drinkers has increased from one in 300 to one in 20. This translates into about five million people addicted to alcohol. There is a need to increase awareness in the medical community on the topic since less relevant in the western countries where Indian immigrants are now settling. We ll present a case of a 35y Indian old man admitted in our first aid for generalized seizures due to acute alcohol abuse.

The patient underwent to a brain CT scan demonstrating a relevant multiple infarct encephalopathy. Alcoholemia was over 500 mg/ml. I.v. diazepam was administered with fluids. The subject fully recovered and was disharged the next day. Seen the vascular burden an anti epileptic treatment was undertaken with oxcarbazepine 600 bid.

A 50-year-old Nigerian man was admitted for generalized non febrile seizures. Two weeks before his GP prescribed antimalaric prophilaxis with clorochine for a planned trip in his home country. He suffered of a minor stroke 2 years before with no residual disability. He had also history of arterial hypertension treated with ace inhibitors and aspirin. At admission he was treated with lorazepam i.v. for a second generalized crisis at admission, and started carbamazepine 1000 per day. No other critical events were found during in hospital staying. A CT scan demonstrated the known subcortical right hemispheric hypodensity with no sulcal effacement or swelling features. Three months later carbamazepine was gradually intterrupted. After few months a new trip to Lagos was planned and chosen an antimalaric prophilaxis with Proguanil/Atovaquone (Malarone). The drug was well tolerated and no side effects were detected.

Take home message:
while choosing antimalaric prophilaxis a medical history of stroke and TIA may encourage the use of non epileptogenic drugs.

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