Alcohol Withdrawal Seizure

Introduction

Alcohol Withdrawal Seizure occurs in chronic alcoholics who abruptly stop drinking and these seizures are generally part of Alcohol (ETOH) Withdrawal Syndrome like DT (Delirium Tremens), but these withdrawal related seizures can occur as isolated condition too without any other major withdrawal manifestations.

The typical seizures in this setting are mostly grand mal type (generalized tonic clonic seizures, also called as GTC). These seizures occur in about 30% of the patients with significant withdrawal manifestations. These seizures start manifesting about 6 hours after the last drink. Majority of them occur within about 2 to 3 days after the last drink however on rare occasions may occur up to a week or so after the last alcoholic drink.

What causes these withdrawal seizures?

Alcohol by nature, especially in large amounts is a brain suppressant. Small amounts might stimulate but large amount of alcohol causes sedation and sleepiness indicating that it is a brain suppressant. On chronic intake of especially large amounts of alcohol several molecular and biochemical changes take place in the bran including alteration in the concentration and activity of neurochemicals like GABA or NMDA activity. One of the results of these above mentioned changes is that brain becomes hyper excitable when the alcohol concentration in the blood diminishes and this results in the various withdrawal manifestations including seizures too.

To keep this hyperactive brain cells under check continuous and adequate amount of alcohol in the blood is necessary, but due to any reasons if a chronic alcoholic unable to drink then the blood alcohol level drops and the brain hyperactive status along with autonomic nervous system hyperactivity will go unchecked.

This will manifest clinically with varieties of alcohol withdrawal syndromes including DT (Delirium Tremens), ETOH withdrawal seizures etc. Patients may also present with abnormal excitement, hallucinations, confusion, palpitation, fever, blood pressure changes etc especially with a full blown Delirium Tremens.

Diagnosis of ETOH withdrawal seizures

The diagnosis of this condition mostly clinical, and a high index of suspicion is necessary on all chronic alcoholic people who presents with seizure activity.

Investigations like CAT scan or MRI scan of the brain & EEG etc are generally not necessary in a typical cause but if the history is not clear and if there is suspicion of any other disease causing seizures then these above mentioned investigations may need to be accomplished.

Treatment

The seizures may be treated with;

• benzodiazepines like diazepam, lorazepam
• Barbiturates like phenobarbitone
• Topiramate
• Phenytoin etc.

All these patients also should get high doses of thiamine (vitamin B1) and other vitamins. Glucose should not be given without thiamine first as it can precipitate a serious condition by name Wernicke encephalopathy/ korsakoff psychosis.

If patient has full blown DT (delirium tremens) it is treated accordingly.

A neurologist is frequently involved in the care of Alcohol Withdrawal Seizure patients.



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