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of idiopathic or posttraumatic epilepsy, the goal of treatment should be abstinence from alcohol, because of the tendency of even short periods of drinking to precipitate seizures Such patients need to be maintained on anticonvulsant drugs Delirium Tremens ( DTs ) This is the most dramatic and grave of all the alcoholic illnesses It is characterized by profound confusion, delusions, vivid hallucinations, tremor, agitation, and sleeplessness, as well as by the signs of increased autonomic nervous system overactivity ie, dilated pupils, fever, tachycardia, and profuse perspiration The clinical features of delirium are presented in detail in Chap 20 as they relate to DTs and to other illnesses that simulate it Delirium tremens develops in one of several settings.

The patient, an excessive and steady drinker for many years, may have been admitted to the hospital for an unrelated illness, accident, or operation and, after 2 to 4 days, occasionally even later, becomes delirious Or, following a prolonged drinking binge, the patient may have experienced several days of tremulousness and hallucinosis or one or more seizures and may even be recovering from these symptoms when delirium tremens develops, rather abruptly as a rule As to the frequency of delirium tremens, Foy and Kay reported an incidence of 065 percent of all patients admitted for other reasons to a large general hospital Among 200 consecutive alcoholics admitted to a city hospital, Ferguson et al reported that 24 percent developed delirium tremens; of these, 8 percent died gures that are considerably higher than those recorded in our hospitals.

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Of course, the reported incidence of delirium tremens will vary greatly, depending on the population served by a particular hospital In the majority of cases delirium tremens is benign and shortlived, ending as abruptly as it begins Consumed by relentless activity and wakefulness for several days, the patient falls into a deep sleep and then awakens lucid, quiet, and exhausted, with virtually no memory of the events of the delirious period Somewhat less commonly, the delirious state subsides gradually with intermittent episodes of recurrence In either event, when delirium tremens occurs as a single episode, the duration is 72 h or less in over 80 percent of cases Less frequently still, there may be one or more relapses, several episodes of delirium of varying severity being separated by intervals of relative lucidity the entire process lasting for several days or occasionally for as long as 4 to 5 weeks.

In the past, approximately 15 percent of cases of delirium tremens ended fatally, but the gure now is closer to 5 percent In many of the fatal cases there is an associated infectious illness or injury, but in others no complicating illness is discernible Many of the patients die in a state of hyperthermia; in some, death comes so suddenly that the nature of the terminal events cannot be determined Reports of a negligible mortality rate in delirium tremens can usually be traced to a failure to distinguish between delirium tremens and the minor forms of the withdrawal syndrome, which are far more common and practically never fatal We make note here of our experience with delirium following the withdrawal of barbiturates, which is almost identical to the DTs, including the abrupt cessation of symptoms, as discussed on page 1022.

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There are also alcohol withdrawal states, closely related to delirium tremens and about as frequent, in which one facet of the delirium tremens complex assumes prominence, to the virtual exclusion of the other symptoms The patient may simply exhibit a transient state of quiet confusion, agitation, or peculiar behavior lasting several days or weeks Or there may be a vivid hallucina-.

Moreover, C makes this decision in time polynomial in the length of I (we can assume that S is itself encoded as a binary string, and we know that the length of this string is polynomial in the length of I) Recall now our argument in Section 77 that any polynomial algorithm can be rendered as a circuit, whose input gates encode the input to the algorithm Naturally, for any input length (number of input bits) the circuit will be scaled to the appropriate number of inputs, but the total number of gates of the circuit will be polynomial in the number of inputs If the polynomial algorithm in question solves a problem that requires a yes or no answer (as is the situation with C: Does S encode a solution to the instance encoded by I ), then this answer is given at the output gate.

Fig. 5-19

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